Silver Hill Hospital Community Health Needs Assessment

Transcription

SILVER HILL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT
February 2014
TABLE OF CONTENTS
Executive Summary .......................................................................................................................................................2
Introduction ...................................................................................................................................................................4
Silver Hill Hospital......................................................................................................................................................4
Definition of Community Served ...............................................................................................................................5
Process and Methods ................................................................................................................................................7
Community Interviews ..............................................................................................................................................8
Community Health Needs Assessment: Data and Research........................................................................................10
Substance Abuse .....................................................................................................................................................10
Alcohol ................................................................................................................................................................10
Illicit Drugs ..........................................................................................................................................................14
Tobacco ...............................................................................................................................................................18
Mental Health .........................................................................................................................................................20
General................................................................................................................................................................20
Mood & Anxiety Disorders ..................................................................................................................................23
Psychotic & Personality Disorders ......................................................................................................................24
Eating Disorders ..................................................................................................................................................25
Suicide .................................................................................................................................................................26
Dual Diagnoses ........................................................................................................................................................28
Community Input and Existing Resources ...................................................................................................................30
Themes from Community Input ..............................................................................................................................30
Existing Resources in the Community .....................................................................................................................38
Prioritized Health Needs of Our Community ...............................................................................................................47
Endnotes ......................................................................................................................................................................50
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February 2014
EXECUTIVE SUMMARY
Silver Hill Hospital (SHH) is a not-for-profit specialty hospital for mental health and substance abuse needs for
adolescents (ages 13-17) and adults (ages 18+). Silver Hill Hospital’s primary community comprises Fairfield
County, Connecticut, a county of an estimated 933,835 residents according to the 2012 U.S. Census. We
determined our community by looking at historical volume experience for inpatient, outpatient and residential
admissions.
Between May and November 2013, we conducted primary and secondary data research and interviewed over 20
community stakeholders to develop the Community Health Needs Assessment and the accompanying 2014-2017
Implementation Plan. We assessed the following issues in our community: 1) Substance Abuse (alcohol, drugs and
tobacco); 2) Mental Health Issues (mood and anxiety disorders, psychotic and personality disorders, eating
disorders and suicide); and 3) Dual Disorders (co-occurring mental health and substance abuse issues). When
possible, we examined Fairfield County or the Southwest Region as opposed to the state of Connecticut or the U.S.
overall. We also paid particular attention to potentially underserved populations in our community including
adolescents and young adults, women, minorities and seniors.
FINDINGS IN BRIEF
Fragmentation of Services. Somewhat counter-intuitively, people on public assistance often have more and better
services than those available to people with insurance, who make up the bulk of Fairfield County. The state system
offers wrap-around services focused on the full continuum of care, housing and supported employment, education
and peer services. There are no corollaries in the private sector. As a result, the mental health system for youth
and adults alike is fragmented and less holistic than it should be. In addition, there is a gap in services for young
adults (ages 18-25). Despite the negative view many hold of the public sector’s mental health and substance abuse
programs, there is something we, as a private-sector provider to a mostly well-off patient population, can learn
from public assistance programs.
Alcohol Abuse Among Adults, Adolescents and Seniors. Fairfield County has a particular problem with alcohol
abuse. The rate for binge alcohol use and alcohol dependence here is higher than in Connecticut and the U.S. as a
whole. The problem is not limited to adults. Connecticut adolescents aged 12-17 are second only to Montana in
binge alcohol use. The growing community of seniors, whose bodies no longer metabolize alcohol in the same way,
are also in danger of abusing alcohol. There is also a treatment gap, with 7.8% of adults aged 12 and over needing
treatment for alcohol use compared to 6.9% nationwide.
Marijuana and Prescription Drug Abuse Among Adults and Adolescents. There is an increasing need for
treatment of illicit drug use in the Southwest Region. Over the last several years, the incidence of prescription drug
abuse has climbed, mirroring national trends. Unfortunately, there is a gap in knowledge in the provider
community regarding treatment for opioid addiction. Marijuana is also a serious issue for adolescents in the
region. Despite its perception as less dangerous than alcohol or other drugs, marijuana is an addictive drug with
long-term side-effects for adolescents. Parents’ understanding the facts and legal implications is critical to
changing use patterns among adolescents in Fairfield County.
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February 2014
Mental Illness Among Young Adults, Women and Hispanics. Adults in Connecticut do not differ significantly from
the U.S. as a whole in major depressive episodes, serious mental illness or suicidal ideation. Young adults (ages 1825), however, have a slightly higher rate of serious mental illness than the U.S. population as a whole. Women
nationwide are more likely than men to report poor mental health; Connecticut is no exception. Girls are also
much more likely to be depressed than boys, and at younger ages. Likewise, Hispanic youth in Connecticut are
more likely to be depressed than others. Stigma associated with seeking medical treatment for mental illness in
the Hispanic community, however, acts as a barrier to care. In general, the high-pressure environment of our
mostly affluent community contributes to pathological behavior, and the community could benefit from education
around coping skills and mindfulness, particularly for the “sandwich generation,” who must care for both aging
parents and school-aged adolescents.
A Dearth of Resources for Eating Disorders. Over 4% of women in Connecticut have an eating disorder, twice the
rate for men. Sadly, the rates in Connecticut are driven by younger teens. According to community stakeholders,
there is a real lack of resources – both inpatient and outpatient – for those suffering from eating disorders. There is
also a lack of understanding by providers, parents and school administrators regarding how to handle an emerging
or suspected eating disorder, particularly for adolescents.
Suicide Among Adolescents and Young Adults. Both adolescents and young adults are disproportionately affected
by suicide in this community as evidenced by the three high school suicides that have taken place this school year.
In the state of Connecticut between 2005 and 2010, suicide was the third leading cause of death among
adolescents aged 10-14, the second leading cause of death among adolescents aged 15-19 and the third leading
cause of death among 20-24 year-olds. The Southwest Region also has a higher rate of alcohol-related suicides
than the rest of the state.
Community Outreach Needed, Particularly to Adolescents, Seniors and Minorities. Silver Hill Hospital has not
fully exhausted its community reach. There are several opportunities to raise visibility of our services, offer
information referrals and provide education -- both for individuals/families and practitioners. We already provide
Grand Rounds programs for practicing clinicians, but there are also school psychologists, guidance counselors,
seniors counselors and other community members who could benefit from professional development. We also
noted a gap in services for some underserved communities including youth, seniors and minorities and learned of
stigma associated with attending a program on the Hospital’s grounds.
PRIORITIES
Based on our research and conversations, we determined the following priorities in meeting community needs
using three criteria: 1) Urgency: How critical is the need?; 2) Size: How big is the need?; and 3) Capacity: How able
are we, as a behavioral health institution, to address the need? Will we make an impact?
We elaborate on the following four priorities in the Implementation Plan: 1) Substance Abuse Programs for Adults
(including Outpatient Detox and Chronic Pain and Recovery); 2) Enhanced Adolescent Programming (including an
enhanced Transitional Living Program and an Intensive Outpatient Program); 3) Enhanced Eating Disorder
Program; and 4) A Community Liaison Position (for outreach to underserved populations including youth and
families, senior citizens and minorities as well as partnering with existing community programs).
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February 2014
INTRODUCTION
Health care costs in the U.S. continue to rise despite efforts to contain them. In fact, the share of GDP devoted to
health care spending grew from 9% of GDP in 1980 to 16% of GDP in 2008, one of the largest increases in the
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developed world.
At the same time, resources available for health care are limited. In order to most effectively and efficiently care
for the health of our population within these restricted means, providers must conduct systematic assessments of
the most pressing needs of their communities. This realization, of course, is nothing new. The importance of
population health assessments was explained nicely 15 years ago in this 1998 article from BMJ:
Distinguishing between individual needs and the wider needs of the community is
important in the planning and provision of local health services. If these needs are
ignored then there is a danger of a top-down approach to providing health services,
which relies too heavily on what a few people perceive to be the needs of the
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population rather than what they actually are.
In this report, we discuss the needs of our community with regard to mental health and substance abuse, and set
forth priorities for addressing those needs.
SILVER HILL HOSPITAL
Silver Hill Hospital (SHH) is a not-for-profit Institution for Mental Diseases as defined under The Social Security Act
1905(i) and Title 42 Paragraph 435.1009 of the Code of Federal Regulations. As a specialty hospital, we have
assessed the mental health and substance abuse needs of our community for those we treat, i.e., adolescents
(ages 13-17) and adults (ages 18+).
SHH’s mission is to provide our patients with the best available treatment of mental illness and addiction and to
offer continuing support, counseling and education to our patients and their families in every phase of illness and
recovery. SHH has first-class hospital staff and a wide range of treatment options encompassing both traditional
medicine and complementary and alternative therapies, as well as family programs which help both patients and
their families cope better. The facility is set within a serene countryside environment that is conducive to healing.
We provide comprehensive treatment for a wide range of disorders -- from schizophrenia to addictions -- and
along the care continuum, including acute inpatient care, residential (transitional living) programs, intensive outpatient programs and, in some cases, a 12-month post-discharge follow-up program. Our affiliation with the Yale
University School of Medicine Department of Psychiatry helps us stay on the cutting edge of treatment advances.
SHH has an 18-bed traditional psychiatric acute care unit plus a 26-bed locked unit for lower-risk inpatients,
including 10 adolescent inpatient beds. SHH also offers six different residential programs -- known as Transitional
Living Programs (TLPs) -- treating the illnesses of addiction, co-occurring disorders, personality disorders, psychotic
disorders and chronic pain and addiction. We also offer four Intensive Outpatient Programs in dual diagnoses and
dialectical behavioral therapy (DBT) as well as a women-only trauma and addiction program.
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February 2014
For the fiscal year 2013 ending February 28, 2013, SHH had 1,877 inpatient admissions and 726 TLP admissions.
About three-quarters of our inpatient admissions came from professional referrals (doctors, hospitals), and the
remaining one-quarter were self- or family referrals. About 20% of all inpatients were adolescents aged 13-17; 55%
were female.
A quarter of the patients who are treated in our inpatient programs continue their treatment in one of our
Transitional Living (residential) programs (TLPs), which provide an intensive behavioral and counseling program in
a more open environment. If a patient in a residential program needs to briefly move back to the inpatient
program for additional stabilization, that move and the transition back to the residential program is easy and
seamless. Silver Hill Hospital's Recovery Support and Follow-up Service (RSFS) is the most comprehensive postdischarge support and follow-up service offered by any psychiatric hospital. Patients discharging from the
Addiction or Co-Occurring Disorders TLP are automatically enrolled in the RSFS for 12 months. The goals of RSFS
are to facilitate a smooth transition from treatment to recovery and to increase the likelihood of continued
recovery during the first critical year.
About two-thirds of inpatients and TLP residents come to SHH with a dual diagnosis: a primary diagnosis of
substance abuse and an associated psychiatric disorder or a primary diagnosis of a psychiatric disorder plus a
secondary diagnosis of a chemical dependency. Very often, an associated disorder is not recognized by the patient
and not identified by the provider. This makes full recovery less likely. At Silver Hill Hospital we put a lot of effort
into identifying these co-occurring or dual problems and treating both of them at the same time. We have 13 fulltime psychiatrists on our staff and a treatment team with extensive training and experience in dual diagnoses.
At Silver Hill Hospital, we understand the impact of a psychiatric and substance use illness on families, and we help
families move beyond the suffering caused by these illnesses. Depending on the program, we offer weekly family
forums, DBT family groups and an intensive four-day family program – all to help family members learn how to
support the patient’s recovery and preserve the stability and integrity of their own lives.
Learn more about Silver Hill Hospital on our website at www.silverhillhospital.org.
DEFINITION OF COMMUNITY SERVED
Silver Hill Hospital’s primary community comprises Fairfield County, Connecticut, a county of an estimated 933,835
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residents according to the 2012 U.S. Census. The Bridgeport-Stamford-Norwalk Metropolitan Service Area (MSA)
comprises the total of Fairfield County with 23 towns: Bethel, Bridgeport, Brookfield, Danbury, Darien, Easton,
Fairfield, Greenwich, Monroe, New Canaan, New Fairfield, Newtown, Norwalk, Redding, Ridgefield, Shelton,
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Sherman, Stamford, Stratford, Trumbull, Weston, Westport and Wilton.
We determined our community by looking at historical volume experience. Over the last five years, SHH had 9,485
inpatient admissions, of which 34% lived in Fairfield County and 62% resided in Connecticut. As for residential and
outpatient programs, last year 22% of our residential patients came from Fairfield and 34% came from
Connecticut. Our Transitional Living Program is internationally regarded and attended. As for outpatient programs,
70% of our patients came from Fairfield County and 80% came from Connecticut.
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February 2014
Fairfield County is made up of 24% youth and adolescents, 14% elderly and 51% women. In addition, 17% of the
community is Hispanic. The table below also shows that Fairfield County is wealthier (higher median household
income) and more educated (higher percentage with at least a Bachelor’s degree) than the state of Connecticut or
the nation as a whole.
Select Fairfield County Demographic Statistics
Fairfield
Basic Demographics
Population, 2012 estimate
% of total state population
Persons under 18 years, percent, 2011
Persons 65 years and over, percent, 2011
Female persons, percent, 2011
Ethnicity
White persons, percent, 2011 (a)
Black persons, percent, 2011 (a)
Persons of Hispanic or Latino Origin, percent, 2011 (b)
White persons not Hispanic, percent, 2011
Education & Economic Indicators
Bachelor's degree or higher, percent of persons age 25+, 2007-2011
Homeownership rate, 2007-2011
Median value of owner-occupied housing units, 2007-2011
Median household income, 2007-2011
Persons below poverty level, percent, 2007-2011
933,835
26%
24%
14%
51%
CT
USA
3,590,347 313,914,040
22%
14%
51%
24%
13%
51%
81%
12%
17%
66%
82%
11%
14%
71%
78%
13%
17%
63%
44%
70%
$466,700
$82,558
8%
36%
69%
$293,100
$69,243
10%
28%
66%
$186,200
$52,762
14%
Source: U.S. Census Bureau. http://quickfacts.census.gov/qfd/states/09000.html
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The map below, from Community Commons shows that Fairfield County has four main areas of density: Stamford,
Norwalk, Bridgeport and Danbury.
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February 2014
The table below, adapted from CDC data, shows that, in general, residents of Fairfield County are more likely to
binge drink than are residents of the state of Connecticut or the nation as a whole. However, Fairfield residents are
also less likely to be smokers or limited in activities by disability, and more likely to be in “excellent” or “very good”
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health and insured than are residents the state of Connecticut or the U.S as a whole.
Behavioral Risk Factors, 2010
Fairfield
CT
USA
5.6%
5.0%
5.0%
20.5%
17.4%
15.1%
10.0%
6.1%
3.9%
29.5%
60.5%
13.2%
9.2%
4.0%
29.2%
57.6%
17.3%
12.4%
4.8%
25.1%
56.6%
14.3%
16.6%
21.2%
67.6%
9.4%
60.4%
11.0%
54.8%
14.9%
91.4%
89.8%
90.2%
88.4%
85.0%
82.2%
Alcohol
Heavy drinkers (adult men having more than two drinks per
day and adult women having more than one drink per day)
Binge drinkers (males having five or more drinks on one
occasion, females having four or more drinks on one occasion)
Tobacco Use
Adults who are current smokers
Smoke every day
Smoke some days
Former smoker
Never smoked
Disability
Adults who are limited in any activities because of physical,
mental, or emotional problems
General Health
Excellent or Very Good
Fair or Poor
Access to Care
Any kind of health care coverage
Adults 18-64 with health care coverage
Source: CDC, Behavioral Risk Factor Surveillance System (2010 data). USA includes States & DC.
http://www.cdc.gov/brfss/index.htm
PROCESS AND METHODS
The core committee for the assessment consisted of Elizabeth Moore, Chief Operating Officer; Heather Porter,
Director of Marketing; and Heidi Leatherman, Director of Accounting. We also employed the resources of an
independent health care consultant, Debra C. Gaisford.
The committee met on May 28, August 14, October 3 and October 15, 2013. We researched available data online,
interviewed community stakeholders and assessed priorities. After we had conducted the assessment, we met
again with the Chief Executive Officer, Dr. Sigurd Ackerman, the Medical Director, Dr. Eric Collins, the Chief
Financial Officer, Ruurd Leegstra and the Director of Social Work, Janet Isdaner, to determine priorities and
address implementation.
On December 5, 2013, we presented our findings and recommendations to the Marketing Committee of the Board
of Directors for its members’ review. The full Board of Directors reviewed the assessment on January 23, 2014.
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February 2014
COMMUNITY INTERVIEWS
We spoke to the following individuals and groups as part of our Community Health Needs Assessment between
May and November 2013.
May 14, 2013
Chronic Pain Recovery Center (CPRC) Open Forum at Silver Hill Hospital. Physicians and outreach
staff from the hospital met with 13 community practitioners, practice managers and Connecticut
State Drug Control officials (Department of Consumer Protection) to discuss the issue of
addiction to opioid-based pain medication as a result of chronic pain.
Jul. 31, 2013
Linda M. Autore, President & CEO of Laurel House, a non-profit organization located in Stamford,
Connecticut that provides resources and opportunities for people living with serious psychiatric
illnesses such as schizophrenia to lead fulfilling and productive lives in the communities where
they live, work and go to school. Ms. Autore is also a member of Silver Hill Hospital’s Board of
Directors.
Aug. 13, 2013
Alan M. Barry, Ph.D., Commissioner of Social Services for the town of Greenwich, Connecticut
and formerly the administrator for the Department of Psychiatry at Norwalk Hospital.
Sep. 17, 2013
Claudette Kunkes, Ph.D., a psychologist in private practice in Fairfield County. She specializes in
providing counseling for adult women. Dr. Kunkes is also a member of Silver Hill Hospital’s Board
of Directors.
Sep. 19, 2013
Barbara Greenberg, Ph.D., a clinical psychologist, is an expert on subjects related to parenting,
teens, communication, love, family and lifestyle. Dr. Greenberg specializes in the treatment of
adolescents. She maintains her full-time private practice in Fairfield County and is the Adolescent
Consultant at Silver Hill Hospital. She writes regularly for such publications as Psychology Today
and the Huffington Post and is the co-author of the book Teenage as a Second Language – A
Parent’s Guide to Becoming Bilingual.
Sep. 19, 2013
Erin Kleifield, Ph.D., a private practitioner specializing in eating disorders and mindfulness.
Sep. 20, 2013
Dan Wartenberg, Chief Executive Officer of the Southwest Connecticut Mental Health System
(SWCMHS), the local mental health authority in Region One for Connecticut’s Department of
Mental Health & Addiction Services (DMHAS).
Sep. 23, 2013
Kate Mattias, MPH, JD, the Executive Director of the Connecticut chapter of the National Alliance
on Mental Illness (NAMI), a nationwide grassroots mental health advocacy organization.
Sep. 26, 2013
Aaron Krasner, MD, a psychiatrist specializing in the treatment of adults, children, adolescents,
and families who resides in Fairfield County and practices privately in New York City. Silver Hill
Hospital recently hired Dr. Krasner to revamp our adolescent transitional living program.
Oct. 1, 2013
Peter Case, former President (still on the Board), and Lorraine Zegibe, Head of Community
Outreach for the Stamford/Greenwich affiliate of NAMI.
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February 2014
Oct. 10, 2013
Jacqueline D’Louhy, MSW, Director of Youth and Family Services for the Town of New Canaan;
Kate Boyle, a Youth and Family Services Specialist with the Town of New Canaan; and Melba
Neville, RN, Senior Services Outreach Worker for the Town of New Canaan.
Oct. 10, 2013
Attended monthly meeting of the Hispanic Advisory Council of Greater Stamford, a network of
social services agencies, employers, professionals and healthcare providers that deliver services
to the Hispanic community of Greater Stamford.
Oct. 17, 2013
Margaret Watt, MPH, Executive Director of the Southwest Connecticut Regional Mental Health
Board, a citizens’ advisory council created by State mandate to assess and promote mental
health and addiction services in Southwestern Connecticut.
Oct. 24, 2013
Bill Piper, Chief Executive Officer of the Waveny Care Network, which provides a comprehensive
continuum of care to older adults, including skilled nursing, assisted living, independent living,
home health care, geriatric care managers and outpatient rehabilitation services in New Canaan
and the surrounding communities.
Nov. 11, 2013
Ingrid Gillespie, Director of the Lower Fairfield County Regional Action Council (LFCRAC), a
regional resource to support local mental health initiatives.
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February 2014
COMMUNITY HEALTH NEEDS ASSESSMENT: DATA AND RESEARCH
We assessed the following issues in our community:



Substance abuse
o Alcohol
o Drugs (including marijuana and prescription medication)
o Tobacco
Mental health issues
o Mood and anxiety disorders (e.g., depression, anxiety, etc.)
o Psychotic and personality disorders (e.g., schizophrenia, borderline personality disorder, etc.)
o Eating disorders (e.g., anorexia, bulimia, etc.)
o Suicide
Dual disorders (co-occurring mental health and substance abuse issues)
When possible, we examined Fairfield County or the Southwest Region as opposed to the population of the state
of Connecticut or the U.S. overall. We also paid particular attention to potentially underserved populations in our
community including:




Adolescents
Women
Hispanics
Seniors
SUBSTANCE ABUSE
The National Center for Addiction and Substance Abuse at Columbia University (CASAColumbia) estimates that
only one in 10 (10.9%, 2.5 million) of those individuals in need of addiction treatment (excluding nicotine) receive
it, leaving a treatment gap of 20.7 million individuals. The proportion of individuals in need of addiction treatment
who actually receive it has changed little since 2002, when 9.8 % of those in need received it. Fortunately, the
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northeast is estimated to have the smallest treatment gap nationwide.
ALCOHOL
Data indicate that one of Fairfield County’s most pressing
substance abuse issue is alcohol, particularly when compared
to the state of Connecticut and the U.S. as a whole. The
statistics below are from the 2008-2010 National Surveys on
Drug Use and Health (NSDUH) sub-state data and include
information for the “Southwest” Region of Connecticut, which
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encompasses most of Fairfield County.
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
Eating Disorders
Suicide
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



February 2014
The rate for binge alcohol use in the last month for individuals aged 12+ (defined as drinking five or more
drinks on the same occasion) was 26.85%, compared to 26.48% in Connecticut and 23.47% in the U.S. as a
whole.
The rate for binge alcohol use in the last month for individuals aged 12-20 was 21.42%, compared to
22.43% in Connecticut and 17.47% in the U.S. as a whole.
The rate of alcohol dependence in the last year was 3.37%, compared to 3.30% in Connecticut and 3.47%
in the U.S. as a whole; the rate of dependence or abuse was 7.86%, compared to 8.01% in Connecticut
and 7.29% in the U.S. as a whole.
The percent of individuals needing but not receiving treatment for alcohol use in the past year was 7.78%,
compared to 7.71% in Connecticut and 6.90% in the U.S. as a whole.
The higher rates of alcohol abuse and dependence in Southwest Connecticut are not offset by higher use rates of
illegal drugs in other parts of the country. In fact, when taken together, abuse or dependence on alcohol or illicit
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drugs in Southwest Connecticut was still slightly higher at 9.37% than the U.S. as a whole (8.89%).
Connecticut Department of Mental Health and Addiction Services (DMHAS) data corroborates national reports. In
Connecticut overall, the percent of primary heroin admissions recently dropped after years of steady increases
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giving rise to alcohol as, once again, the most frequently reported substance at admission. (This trend could,
however, be driven by the fact that insurance companies are increasingly denying authorization to patients for
opioid detoxification. See the section on Illicit Drugs for more information.)
The table below shows binge alcohol use, a leading indicator for alcohol abuse issues, in Connecticut and the
Southwest Region. In both the state and sub-state surveys our state and region fared worse than the nation
overall. And while the state rate declined on par with the U.S. rate between the 2008-2009 and 2010-2011 surveys,
the Southwest Connecticut rate increased 0.2% between the 2006-2008 and 2008-2010 surveys. In fact, in the
th
2008-2010 survey, Southwest Connecticut was 60 among 407 regions and catchment areas in the U.S. for binge
th
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drinking among individuals aged 12 and older, up from 67 place in the prior survey.
Binge Alcohol Use in the Past Month
NSDUH
Location
12+
Total U.S.
Connecticut
23.5%
27.0%
Southwest CT
26.7%
Total U.S.
Connecticut
22.9%
26.3%
2008, 2009, 2010
Substate Data
Southwest CT
26.9%
Change between
Surveys
Total U.S.
Connecticut
Southwest CT
-0.7%
-0.7%
0.2%
2008-2009 State Data
2006, 2007, 2008
Substate Data
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February 2014
More locally, in 2007, alcohol was the most common primary drug for patients admitted for publicly funded
treatment from each of the four towns in Sub-Region 1A of the Southwest Connecticut Region: Darien (53%),
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Greenwich (52%), New Canaan (53%) and Stamford (35%).
Sub-Region 1C (Greater Bridgeport) demonstrates similar, pervasive issues. For example, a 2006 random digit dial
survey of Bridgeport households found that one third of Bridgeport residents reported having had an alcoholic
drink during the past 30 days. Drinking was more prevalent among the unemployed (49%) and Portuguese
speakers (62%). Higher rates of drinking were also reported by those who were college educated (42%) and those
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making more than $50,000 per year (59%).
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The map below from Community Commons contains Behavioral Risk Factor Surveillance System (BRFSS) data
from the CDC between 2005 and 2011 for Fairfield County. It indicates that Fairfield County is consistently in the
highest category (above 18%) in the nation when it comes to adults aged 18 and over who are heavy drinkers.
SPOTLIGHT ON UNDERSERVED POPULATION: ADOLESCENTS
The table below demonstrates Fairfield County’s issue with alcohol. In both surveys, Connecticut adolescents aged
12-17 were second only to Montana in their binge alcohol in the last month at a rate of 13.3% in 2008-2009 and
10.2% in 2010-2011. These rates are well above the national rates. Some progress was made between 2009 and
2011, for the rate decreased 3.1%, faster than the national rate. Note, however that the young adult population
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aged 18-25 (half of which is still underage) actually increased its rate of binge drinking between the two surveys.
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February 2014
Binge Alcohol Use in the Past Month
NSDUH
Location
12+
12-17
18-25
26+
Total U.S.
Connecticut
23.5%
27.0%
8.9%
13.3%
41.5%
46.9%
22.3%
25.6%
Total U.S.
Connecticut
22.9%
26.3%
7.6%
10.2%
40.1%
48.0%
21.8%
24.8%
Change between
Surveys
Total U.S.
Connecticut
-0.7%
-0.7%
-1.3%
-3.1%
-1.4%
1.1%
-0.5%
-0.8%
The CDC’s Youth Risk Behavior Survey (YRBS) further emphasizes the region’s issue with alcohol. Across
th
th
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Connecticut, of 9 -12 graders surveyed in 2011:



15.6% admitted to trying alcohol before the age of 13, compared to 20.5% in the U.S. as a whole. This
figure rose to 20.7% for Hispanic and Latino teens in Connecticut.
41.5% drank alcohol at least one day in the last 30 days, compared to 38.7% in the U.S. as a whole.
22.3% binged on alcohol in the last 30 days, compared to 21.9% in U.S. as a whole.
In Fairfield County, adolescent patterns are no different than those of adults, showing better statistics than the
state of Connecticut but worse than the U.S. as a whole:




In the Southwest Region, 30.62% of individuals aged 12-20 consumed alcohol in the past month compared
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to 31.35% in Connecticut and 26.54% nationally.
In the Southwest Region, 21.42% of individuals aged 12-20 engaged in binge drinking compared 26.48% in
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Connecticut and 17.47% nationally. (The high rates of adolescent binge drinking in Connecticut appear
to be driven by the Eastern Region, which had a rate of 24.1%.)
In 2005, there were 318 treatment admissions for underage (ages 12-20) drinking (rate of 33.3
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adolescents per 10,000).
In 2008, almost 60% of 9th-12th graders reported alcohol use in the past 30 days and 5% reported having
used alcohol 10 or more times in the past month in Sub-Region 1A of Southwest Connecticut (includes
20
Darien, Greenwich, New Canaan and Stamford).
SPOTLIGHT ON UNDERSERVED POPULATION: SENIORS
According to the NIH, as people age, they may become more sensitive to alcohol's effects. One reason is that older
people metabolize alcohol more slowly. Also, the amount of water in the body decreases with age. As a result,
older adults have a higher percentage of alcohol in their blood than younger people – or than they used to -- after
drinking the same amount. Aging lowers the body's tolerance for alcohol, causing older adults to experience the
effects of alcohol, such as slurred speech and lack of coordination, more readily than when they were younger. An
older person can develop problems with alcohol even though his or her drinking habits have not changed. Finally,
21
many medicines interact with alcohol and can be harmful to older adults.
13
February 2014
A July 2012 report from SAMHSA indicates that, by 2020, the number of adults aged 50 or older needing substance
abuse treatment is expected to double from 2.8 million (2002 to 2006 annual average) to 5.7 million. According to
the Treatment Episode Data Set (TEDS), substance abuse treatment admissions of individuals aged 50 or older
increased by nearly 50% between 2004 and 2009. Unfortunately, data from the National Survey of Substance
Abuse Treatment Services (N-SSATS) show that in 2009 fewer facilities offered special programs or groups for
22
seniors or older adults than in 2004.
ILLICIT DRUGS
Data indicate that while there is a fair amount of illegal drug
use in the Southwest Region, prevalence rates are lower than
for the state of Connecticut or the U.S. as a whole.
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
For example, 2.67% of Southwest Region residents aged 12
and over said they were dependent on or abused illicit drugs
in the past year, compared to 2.88% in Connecticut and 2.82%
23
in the U.S. as a whole.
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
In terms of treatment, 2.23% of Southwest Region residents
Eating Disorders
needed but didn’t receive treatment for illicit drug use in the
Suicide
last year, compared to 2.42% in Connecticut and 2.54% in the
24
U.S. Notably, in the prior NSDUH (2006-2008), the Connecticut and U.S. rates were comparable (2.41% and
25
2.53%, respectively) but the Southwest Region figure was lower at 1.90%, indicating that there is an increasing
need for treatment of illicit drug use in our Region, even though it is lower than the state or national rates.
Almost a third of all drug- and alcohol-related admissions to substance abuse services in the state of Connecticut
come from young adults aged 20-29. Certain drugs are worse than others. This cohort makes up 58% of the
26
admissions for PCP, and 50% each of admissions for hallucinogens and marijuana.
Cocaine
In the Southwest Region, 1.66% of adults aged 12 and over used cocaine in the past year, according to the 200827
2010 NSDUH, compared to 1.82% in Connecticut and 1.94% nationally. These figures have all decreased nicely
from the 2006-2008 study which found use rates of 2.41% in the Southwest Region, 2.35% in Connecticut and
28
2.33% nationally.
State data from the 2011 NSDUH, however, shows that young adults aged 18-25 are truly driving the rate across
29
the state, with 5.7% young adults having used cocaine in the past year compared to 4.6% nationally. In addition,
data from the 2006 Core Survey of Connecticut college students found that the prevalence of current cocaine use
30
increased from 2.7% in 2001 to 3.0% in 2006.
14
February 2014
Opioids: Heroin and Pain Relievers
Primary admissions for heroin use decreased 36% in Connecticut between 2000 and 2010, from 601 to 382
admissions per 100,000 individuals aged 12 and over, but the rate is still nearly 300% higher than the 2010 national
31
rate of 97 admissions per 100,000 adults.
Overdose deaths from controlled prescription drugs have increased significantly over recent years and now
surpass the number of overdose deaths caused by illicit drugs. In the U.S. in 2008, 73.8% (14,800) of overdose
32
deaths were attributable to prescription opioids.
Primary admissions for pain medication use increased 265% in Connecticut between 2000 and 2010, from 23 to 84
admissions per 100,000 individuals aged 12 and over, compared to an even greater increase (but still lower
33
absolute figure) of 400% nationwide to 60 admissions per 100,000 adults.
Compared to the U.S. rate of 4.57%, Connecticut’s rate of non-medical use of pain relievers is estimated to be
34
slightly lower, at 4.38% of the adult population (aged 12+) according to the most recent 2011 NSDUH, which is
higher than the 3.88% rate found in prior survey (2008-2010). The rate in the Southwest Region was estimated at
35
3.52% in the 2008-2010 survey. For young adults (aged 18-25) in Connecticut, the rate of non-medical use of pain
36
relievers was about two and a half times the general adult population at 10.7% (similar to the national ratio). The
concern is that evidence shows that many people who become addicted to prescription pain relievers move to
37
heroin as a cheaper and more readily available alternative.
Interpreting the decline in opioid-based primary admissions, however, is complicated by the fact that
increasingly, insurance companies view opioid detoxifications as non-life-threatening and therefore not in need
of an inpatient stay. In fact, according to our Admissions department, one of the most common reasons
individuals who call are not admitted is for seeking inpatient detoxification services their insurance companies will
not authorize.
Unfortunately, there is a significant gap in knowledge in the provider community regarding treatment for opioid
addiction. Although buprenorphine (Suboxone), is a clinically effective and cost-effective pharmaceutical
treatment for opioid addiction, it is under-utilized by physicians and addiction counselors. Researchers at
CASAColumbia found that the majority (86%) of addiction counselors reported not being aware of the
effectiveness of buprenorphine. And a random sample of internal medicine, family medicine, psychiatry and pain
management physicians in Maryland found that only 36% of respondents were willing to prescribe buprenorphine
38
to an established patient and only 28% were willing to prescribe the medication to a new patient. In addition, a
report from DMHAS in 2012 found that a third of surveyed agencies in Region 1 (which encompasses most of
39
Fairfield County) were unsure of where to refer a client for a buprenorphine maintenance program.
Marijuana
Marijuana access and use is increasingly becoming a problem in our community and nationwide. Primary
admissions for marijuana use doubled in Connecticut between 2000 and 2010, from 137 to 273 admissions per
100,000 individuals aged 12 and over, compared to only a 20% increase nationwide to 127 admissions per 100,000
40
adults. The rate in Connecticut is now more than double that of the national rate.
15
February 2014
The table below, based on 2006-2008 and 2008-2010 NSDUH data, illuminates some differences between the U.S.,
41
the state of Connecticut and regional rates of drug use over time. Although the Southwest Region is better off
than Connecticut or the U.S. as a whole, the data show a trend towards increased use and acceptance of
marijuana.
U.S.
Connecticut
SW Connecticut
Marijuana Use in Past Month (’06-‘08)
6.01%
6.58%
5.06%
Marijuana Use in Past Year (’06-‘08)
10.31%
11.53%
9.67%
Perceptions of Great Risk of Smoking Marijuana
Once a Month (’06-‘08)
38.18%
35.83%
36.10%
Marijuana Use in Past Month (’08-‘10)
6.58%
7.55%
5.89%
Marijuana Use in Past Year (’08-‘10)
11.13%
13.01%
9.73%
Perceptions of Great Risk of Smoking Marijuana
Once a Month (’08-‘10)
34.70%
32.51%
31.46%
SPOTLIGHT ON UNDERSERVED POPULATION: ADOLESCENTS AND HISPANIC YOUTH
Cocaine
th
th
Data on 9 -12 graders from the 2011 YRBS show that Connecticut does not have a significantly worse illicit drug
problem than the U.S. as a whole, with the exception of cocaine. Yet, the data also indicate that Hispanic youth are
particularly vulnerable to substance abuse issues in Connecticut, with nearly double the rate of heroin use and
42
more cocaine/crack use:
Ever Used/Done:
Connecticut All
Connecticut Hispanic
U.S.
Cocaine/Crack
5.0%
7.1%
3.0%
Heroin
2.9%
4.6%
2.9%
Inhalants
9.0%
10.5%
11.4%
Meth
3.2%
3.7%
3.8%
Ecstasy
6.3%
9.2%
8.2%
Opioids: Heroin and Pain Relievers
Of the teens surveyed by CASAColumbia in 2011, 23% indicated that they knew at least one friend or classmate
who used prescription drugs without a prescription to get high. This rate shows no change from prior years: 21% in
43
2007, 24% in 2008, 25% in 2009 and 25% in 2010. As we are learning, many adolescents have access to such
prescription medication via their parents’ medicine cabinet.
16
February 2014
Marijuana
Marijuana is a serious issue for adolescents in the region. Despite its perception as less dangerous than alcohol or
other drugs, marijuana is an addictive drug with long-term side-effects for adolescents. Some important statistics
44
include:



Lifetime risk of dependence rises from 9% to nearly 17% if marijuana smoking is initiated in adolescence.
Adolescents who started smoking marijuana between the ages of 14 and 22 but stopped by age 22 still
had greater cognitive problems at age 27 than those who started smoking marijuana as adults.
Compared to controls and individuals who started marijuana use after age 17, those who smoked
marijuana before age 17 had greater deficits in executive function, memory, verbal fluency and learning.
In a 2011 study by CASAColumbia 22% of teens reported that marijuana is the easiest drug to obtain compared to
cigarettes, beer and prescription painkillers. That is nearly a 50% increase from the prior year, when only 15% of
45
teens named marijuana as the easiest to obtain.
In the most recent NSDUH (2010-2011), 16.25% of Connecticut teens aged 12-17 had used marijuana in the last
46
year, compared to 13.39% of the general adult population (ages 12+) and 14.13% of teens nationwide. The
16.25% figure also represents an increase from the prior survey (2008-2009), which found that 15.9% of
47
Connecticut teens had used marijuana in the prior year.
Data from the CDC’s 2011 Youth Risk Behavior Survey indicates that Hispanic youth in Connecticut are starting
th
th
marijuana use earlier than their peers in Connecticut and the U.S.: According to the survey of Connecticut 9 -12
graders in 2011, 6.3% tried marijuana before they were 13, compared to 8.1% in the U.S. as a whole and 8.4% for
48
Hispanic teens in Connecticut. In Sub-Region 1A (Darien, Greenwich, New Canaan and Stamford), two local drug
treatment programs found in the last few years that almost 60% of youth entering substance abuse treatment
49
have smoked marijuana.
SPOTLIGHT ON UNDERSERVED POPULATION: WOMEN
According to a July 2013 study by the CDC, deaths from prescription painkiller overdoses among women have
increased more than 400% since 1999, compared to 265% among men. For every woman who dies of a
prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse. What is more,
women aged 25-54, of which there are an estimated 198,000 in Fairfield County, are more likely than other age
groups to go to the emergency department from prescription painkiller misuse or abuse. Women aged 45-54, of
which there are an estimated 75,000 in Fairfield County, have the highest risk of dying from a prescription
50,51
painkiller overdose.
17
February 2014
TOBACCO
The most recent NSDUH sub-state data (2008-2010) reported
that 19.54% adults aged 12 and over in the Southwest Region
smoked in the past month, compared to 21.56% in
52
Connecticut and 23.46% in the U.S. as a whole. These figures
are slightly lower than the 2006-2008 sub-state data of
53
19.61%, 21.29% and 24.6%, respectively. In fact, data over
time from the NSDUH shows that cigarette smoking in
54
Connecticut has been steadily decreasing since 1999.
Analysis by the Kaiser Family Foundation also found that
adults in Connecticut were less likely to smoke across the
board and more likely to have attempted to quit in the last
55
year. The table below summarizes this data.
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
Eating Disorders
Suicide
Percent of Adults Who Smoke, 2011
Location
United States
Connecticut
All Adults
20.1%
17.1%
Male
22.6%
19.0%
Female
17.7%
15.4%
White
20.8%
16.8%
Black
23.1%
20.8%
Percent of Adults Who Attempted to Quit Smoking, 2011
Location
United States
Connecticut
All Adults
59.6%
62.1%
Male
59.1%
61.8%
Female
60.1%
62.4%
Likewise, residents of Fairfield County are less likely to smoke than individuals in the U.S. as a whole:


56
Current smokers = 10.0%, compared to 13.2% in Connecticut and 17.3% in the U.S. as a whole
57
Adult smokers (2005-2011) = 12%, compared to 15% in Connecticut and 13% in the U.S. as a whole
58
The map below from Community Commons corroborates this data. It contains Behavioral Risk Factor Surveillance
System (BRFSS) data from the CDC between 2005 and 2011 indicating that Fairfield County has a low rate of adult
smoking.
18
February 2014
A 2011 report from Columbia University found that teens who have used tobacco are 11 times likelier to have used
59
marijuana than teens who have never used tobacco. According to the 2011 Youth Behavior Risk Survey, tobacco
th
th
60
use among all 9 -12 graders in Connecticut was as follows:


15.9% smoked cigarettes one day in the last 30 days, compared with 18.1% in the U.S. overall (both lower
than the rate for adults)
5.4% smoked cigarettes 20 of the last 30 days, compared with 5.4% in the U.S. overall
Interestingly, although Hispanic teens were more likely than the overall cohort to have smoked cigarettes once in
61
the last 30 days (16.5%), they were less likely to have smoked 20 of the last 30 days (4.7%), i.e., be regular
smokers.
Also troubling is a recent report from the CDC, which found, through its 2011-2012 National Youth Tobacco Survey
(NYTS) that electronic cigarette (“e-cigarette”) use among middle and high school students doubled to nearly 7%.
An estimated 1.78 million teens nationwide had used an e-cigarette in 2012. According to the report, concerns
include “the potential negative impact of nicotine on adolescent brain development, as well as the risk for nicotine
62
addiction and initiation of the use of conventional cigarettes or other tobacco products.”
SPOTLIGHT ON UNDERSERVED POPULATION: WOMEN AND MINORITIES
Although smoking overall in Connecticut is better than the U.S. as a whole, the Kaiser Family Foundation
uncovered certain disparities between Whites and minorities for both men and women. In its analysis, a disparity
score greater than 1.00 indicates that minorities are faring worse than whites. A disparity score less than 1.00
19
February 2014
indicates that minorities are doing better than whites. A disparity score equal to 1.00 indicates that minorities and
whites are doing the same.
The table below shows that minority men in Connecticut are faring worse in smoking rates than White men in
the state (Disparity Score = 1.11). The data indicate that Hispanic men (26.3% smokers versus 23.3% nationally)
and Asian/Native Hawaiian/Pacific Islander men (18.3% versus 15.8% nationally) are driving the disparity. It is
worth noting, too, that men are more likely to smoke across the board than women.
Minority women in Connecticut are not facing the same absolute challenges versus Whites, but relative to the U.S.
as a whole, disparities in Connecticut among these women are more pronounced. Non-Hispanic Black women
(20.4% smokers versus 18.6% nationally) and Hispanic women (17.9% smokers versus 10.8% nationally) seem to be
63
driving this trend.
Men’s Smoking by Race/ Ethnicity, 2006 – 2008
Data are for men ages 18–64.
Location
Disparity
Score
United States
Connecticut
0.95
1.11
All Men
NonHispanic
White
All
Minority
NonHispanic
Black
Hispanic
Asian and
NHPI
25.0%
21.8%
25.2%
21.3%
23.9%
23.6%
26.9%
22.3%
23.3%
26.3%
15.8%
18.3%
Women’s Smoking by Race/Ethnicity, 2006-2008
Data are for women ages 18–64.
Location
Disparity
Score
All
Women
NonHispanic
White
All
Minority
NonHispanic
Black
Hispanic
Asian and
NHPI
United States
Connecticut
0.61
0.92
20.7%
17.9%
23.1%
18.2%
14.0%
16.6%
18.6%
20.4%
10.8%
17.9%
7.4%
2.4%
MENTAL HEALTH
Scientists estimate that one in four people is affected by mental illness, either directly or indirectly through their
64
families.
GENERAL
According to the 2011 NSDUH, 19.6% of adults (ages 18+) in the U.S. have a mental illness, of which 10.7% is
“mild,” 3.9% is “moderate” and 5.0% is “serious.” The gender break-down is 15.9% of males and 23.0% of females.
In the Northeast, 18.4% of adults have a mental illness, of which 4.1% is “serious.” And foreshadowing the rest of
this section, young adults aged 18-25 have a much higher rate of mental illness than the population overall, at
65
29.8%.
In Connecticut, according to SAMHSA data from the combined 2010 and 2011 NSDUHs, adults do not differ
significantly from the U.S. as a whole in major depressive episodes (6.42% of adults 18+ as compared to 6.70% in
the U.S.), serious mental illness (4.75% compared to 4.99% in the U.S.) or suicidal ideation (3.62% compared to
20
February 2014
3.75% in the U.S.). They do, however, seem to have a lower rate of “any mental illness” (18.61% of adults 18+ as
66
compared to 19.83% in the U.S. and 16.85% of adults 26+ as compared to 18.08% in the U.S.).
According to SAMHSA data from the combined 2010 and 2011 NSDUHs, young adults in Connecticut have a
slightly higher rate of “serious mental illness” (7.89% of those aged 18-25) than the U.S. population as a whole
67
(7.69%). Indeed, for young adults aged 18-25 reporting “serious psychological distress” on the 2005 and 2006
68
NSDUHs, Connecticut is in the second highest category nationwide with 19.19-19.88% of individuals.
According to state-level analyses by the Kaiser Family Foundation, Connecticut fares slightly worse than the U.S. as
a whole when it comes to self-reported mental health over the last 30 days, with 36.2% of adults aged 18 and over
69
reporting poor mental health compared to 35.8% in the U.S.
The gender breakdown of the Kaiser analysis shows that, as expected, women are more likely than men to report
poor mental health; Connecticut is no exception. However, men in Connecticut seem to be faring slightly worse
(33.5%) than the U.S. overall (31.1%), whereas Connecticut women (38.8%) are faring slightly better than women
70
in the U.S. overall (40.3%).
The breakdown by race and ethnicity indicates that, while in the U.S. as a whole Blacks and Hispanics report poor
mental health, in Connecticut, Blacks were least likely to report poor mental health in the past 30 days of the three
race/ethnicity categories. Both Whites and Hispanics were more likely to report poor mental health in
Connecticut than in the U.S. as a whole. (Note: for other races/ethnicities, there was insufficient data to compare
71
Connecticut to the U.S.).
Percentage of Adults Reporting Poor Mental Health, 2011
Location
United States
Connecticut
All Adults
35.8%
36.2%
Location
United States
Connecticut
Male
31.1%
33.5%
Female
40.3%
38.8%
Location
United States
Connecticut
White
35.2%
36.3%
Black
37.2%
31.5%
Hispanic
37.6%
39.7%
Kaiser also provides disparity scores for its indicators. A disparity score greater than 1.00 indicates that minorities
are doing worse than whites. A disparity score less than 1.00 indicates that minorities are faring better than
whites. A disparity score equal to 1.00 indicates that minorities and whites are doing the same.
The table below shows that minority men in Connecticut are doing better than minority men in the U.S. as a
whole. Minority women, however, seem to be doing worse than minority women in the U.S. as a whole. For
poor physical or mental health in the last 30 days in particular, minority women fare worse in Connecticut than
72
white women (disparity score > 1.00).
21
Men’s Serious Psychological Distress in Past Year, 2004 – 2007
Days Men’s Physical or Mental Health was Not Good in Past 30 Days, 2006 – 2008
Women’s Serious Psychological Distress in Past Year, 2004-2007
Days Women’s Physical or Mental Health was Not Good in Past 30 Days, 2006 – 2008
February 2014
Disparity Score
U.S.
CT
0.97
0.88
1.06
0.98
0.83
0.85
0.99
1.01
Using combined data from 2005-2011, Fairfield County demonstrated an average number of “poor mental health
73
days” of 2.8 in the last 30 days as compared to 3.1 in Connecticut and 2.3 in the U.S. as a whole.
SPOTLIGHT ON UNDERSERVED POPULATION: ADOLESCENTS AND CHILDREN
In a 2012 study conducted by the Hartford-based Center for Children’s Advocacy, researchers found that almost
th
20% of “children with co-morbid mental and behavioral risk factors were not identified until 6-9 grades… and one
out of four students did not receive special education services despite documentation of emotional and behavioral
74
problems and poor academic progress.”
However, according to the Kaiser Family Foundation, 65% of children (ages 2-17) with emotional, developmental
75
or behavioral problems received mental healthcare in 2011, as compared with only 61% in the U.S. as a whole.
SPOTLIGHT ON UNDERSERVED POPULATION: HISPANICS
According to epidemiological research, “Latino adults in need of mental health care are less likely than non-Latino
Whites to access mental health services, and when they do receive care, it is more likely to be poor in quality,”
although women were more likely to access services than men. The studies also found that, “[l]ow acculturation
level was also found to be negatively related to mental health service use,” indicating that cultural factors play a
76
big role in accessing specialty mental health services.
According to the American Psychiatric Association (APA), Hispanics suffer from mental health issues at the same
rate as other populations (or even more, in recent years), but “fewer than 1 in 11 contact a mental health
specialist, while fewer than 1 in 5 contact general health care providers. Even fewer Hispanic immigrants seek
these mental health services.” Instead, Hispanics tend to “rely on their extended family, community, traditional
healers, and/ or churches for help during a mental health crisis.” Key barriers to accessing mental health treatment
include economic barriers (cost, lack of insurance), lack of awareness about mental health issues and services and
77
stigma associated with mental illness. Says Henry Acosta, Director of the National Resource Center for Hispanic
Mental Health, “Latinos always hear how they have to be self-reliant when they have problems or even turn to
78
prayer.” Also important are issues such as language barriers and a lack of culturally appropriate services.
22
February 2014
MOOD & ANXIETY DISORDERS
According to the National Institutes on Mental Health (NIMH),
each year about 6.7% of U.S adults experience major
depressive disorder, and anxiety disorders affect about 18%
79
of adults. Assuming these statistics hold true in Fairfield
county, about 47,000 adults (ages 18+) suffer from depression
and 127,000 adults suffer from anxiety, based on 2012 Census
data.
In 2005-2008, 11% of Americans aged 12 and over took
80
antidepressant medication nationwide. Applied to Fairfield
County, this figure would imply that between 80,000 and
90,000 people take antidepressant medication.
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
Eating Disorders
Suicide
SPOTLIGHT ON UNDERSERVED POPULATION: WOMEN AND GIRLS
According to NIMH, women are 70% more likely than men to experience depression during their lifetime. The
81
average age of onset is 32 years old. The 2011 NSDUH survey corroborated this evidence. In 2011, while 6.6% of
all adults aged 18 and over had a major depressive episode (MDE) in the past year, the gender breakdown was
4.7% of men and 8.3% of women. When zeroing in on the young adult population aged 18-25, the gender disparity
82
was even more stark: 5.7% of men versus 11.0% of women in that age group had an MDE in the past year.
Before adolescence, girls and boys experience depression at about the same frequency. By adolescence, however,
83
girls become more likely to experience depression than boys. In fact, nationwide among adolescents aged 12-17,
12.1% of girls had a major depressive episode (MDE) in the last year versus 4.5% of boys.
84
In Connecticut, according to the 2011 YRBS, there was also a big discrepancy between the sexes, with 31.0% of all
girls overall feeling depressed versus 18.0% of boys, but each figure was still less than the U.S. as a whole: 35.9% of
girls and 21.5% of boys.
85
Nationwide, 8.2% of adolescents aged 12-17 had a major depressive episode (MDE) in the last year according to
the 2011 NSDUH. Girls were much worse off in this category, with 12.1% an MDE in the last year, compared to
boys, 4.5% of whom experienced an MDE.
86
87
Women are 60% more likely than men to experience an anxiety disorder over their lifetime. Women are also
more prone than men to having a coexisting anxiety disorder. Women suffering from PTSD, which can result after a
88
person endures a terrifying ordeal or event, are especially prone to having depression.
Not only are girls worse off than boys when it comes to depression, but it is occurring at younger ages. The 2011
NSDUH found that in the past year, 4.1% of 12-13 year-olds, 8.6% of 14-15 year-olds and 11.7% of 16-17 year-olds
had a MDE. In the Northeast, the overall adolescent rate is slightly lower, at 7.4%.
89
23
February 2014
A large, national survey of adolescent mental health conducted by NIMH reported that about 8% of teens aged 1318 have an anxiety disorder, with symptoms commonly emerging around age six. However, of these teens, only
90
18% received mental health care. Additionally, 3.3% of 13 to 18 year-olds have experienced a seriously
91
debilitating depressive disorder. Indeed, these statistics have led the federal government to assign Leading
Health Indicator status to its Healthy People 2020 objective to “reduce the proportion of adolescents aged 12 to 17
92
years who experience major depressive episodes” (MHMD-4.1).
In Connecticut, according to the 2011 YRBS, 24.4% of high school students “felt so sad or hopeless almost every
day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months,”
although this was less than the 28.5% rate in the U.S. overall.
93
Hispanic youth in Connecticut were much more likely to be depressed than the overall cohort, with 33.5% of
Hispanic youth overall, 41.1% of Hispanic girls and 27.0% of Hispanic boys. As compared to the U.S. overall, the
Hispanic girls’ rate in Connecticut was almost identical to that of girls in the U.S. overall (41.4%), but Hispanic boys
94
in Connecticut were more likely to answer yes to the question than boys in the U.S. as a whole (24.4%). One
explanation behind this discrepancy is that Hispanic youth suffer from many of the same emotional problems
created by marginalization and discrimination in our society, but without the secure identity and traditional values
95
held by their parents.
SPOTLIGHT ON UNDERSERVED POPULATION: SENIORS
According to a 2012 report by the Institute of Medicine, nearly 20% of older adults have one or more mental
health or substance abuse conditions. Depression and dementia are the most prevalent, but substance use and
abuse is a significant problem as well. (See the section on Alcohol above.) Losses that occur frequently in old age,
such as the death of a spouse, may trigger or worsen depression and anxiety. It can be difficult to distinguish
between clinical depression and grief. Plus, cognitive and sensory impairments can complicate detection and
96
diagnosis.
97
Based on Fairfield County’s 2012 Census, 13.7% of the population is aged 65 and older. That means more than
125,000 seniors in the community are likely suffering from depression, substance abuse or both.
PSYCHOTIC & PERSONALITY DISORDERS
According to NIMH, about 1.6% of adults in the U.S. have
Borderline Personality Disorder (BPD) in a given year. BPD
98
usually begins during adolescence or early adulthood. In
99
addition, 75-90% of those diagnosed with BPD are women.
About 1% of adults has Schizophrenia, which affects men and
women equally. It occurs at similar rates in all ethnic groups
around the world. Symptoms such as hallucinations and
100
delusions usually start between ages 16 and 30. About
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
Eating Disorders
Suicide
24
300,000 new cases of schizophrenia are diagnosed each year.
February 2014
101
Based on Connecticut Census data for 2012, Fairfield County has about 7,000 adults with Schizophrenia and 11,000
adults with BPD.
In 2010, there were nearly 20,000 inpatient hospital discharges for psychotic conditions among Connecticut
102
residents, with an average length of stay of seven days.
EATING DISORDERS
Nationwide, eating disorders affect women and adolescents
disproportionately, and our community is no different. In fact,
over 4% of women in Connecticut have an eating disorder,
103
twice the rate for men.
National prevalence rates from the National Eating Disorder
Association (NEDA) and NIMH are shown in the table
104
below.
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
Eating Disorders
Suicide
Prevalence Data
NEDA (2011) (1)
Adolescent Prevalence (Lifetime)
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge Eating Disorder (BED)
General
Adult Prevalence (Lifetime)
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge Eating Disorder (BED)
0.3%
0.9%
1.6%
2.8%
NIMH (2007) (2)
Overall Female
Male
2.7%
0.6%
0.6%
2.8%
0.9%
0.5%
3.5%
0.3%
0.1%
2.0%
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Using census demographic data, we determined that there are approximately 1,740 adolescents (ages 15-19)
with an eating disorder, of which 43% have Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Likewise, there are
approximately 4,900 adult females and 1,270 adult males with AN or BN, for a total of over 6,900 individuals
suffering from AN or BN in Fairfield County.
With regard to Binge Eating Disorder, prevalence rates indicate there are nearly 1,000 adolescents and over
18,600 adults suffering in the community.
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February 2014
The CDC’s YRBS 2011 survey offers some interesting facts about Connecticut teens. Although the rate of food
restriction was lower in Connecticut than in the U.S. as a whole, it is clear from these numbers that women are
disproportionately affected by disordered eating. Among the Hispanic community, however, rates for this type of
restriction were higher across the board, and, in an inversion of the usual statistics, males were more likely to
restrict food than were females. (See table below.)
th
A second somewhat surprising finding was that the numbers in Connecticut were driven by younger teens (9
th
graders). In fact, nearly 18% of the 9 grade girls surveyed indicated that they had not eaten for 24 or more hours
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during the 30 days before the survey due to weight considerations.
Did not eat for 24 or more hours to lose weight or to keep from gaining weight (during the 30 days before the survey):
Overall
Female
Male
US, All Races, All Grades
12.2%
17.4%
7.2%
CT, All Races, All Grades
8.9%
11.6%
6.2%
CT, Hispanic, All Grades
11.9%
10.1%
13.3%
CT, White, All Grades
8.0%
12.0%
4.2%
CT, All, 9th Grade
12.8%
17.8%
7.9%
CT, All, 10th Grade
7.2%
9.1%
5.4%
CT, All, 11th Grade
8.6%
10.1%
7.0%
6.7%
9.1%
4.4%
CT, All, 12th Grade
It is no wonder, then, that the federal government has set as a major goal of its Healthy People 2020 initiative to
reduce the proportion of adolescents who engage in “disordered eating” from 14.3% in 2009 to 12.9% in 2020
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(MHMD-3).
SUICIDE
One of the two Mental Health Leading Health Indicators from
the U.S. Department of Health and Human Services’ “Healthy
People 2020” initiative is reducing the suicide rate (MHMD-1).
In 2007, the national rate for suicide was 11.3 suicides per
100,000 people. The goal for 2020 is a 10% reduction in the
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rate to 10.2 suicides per 100,000.
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
According to a recent CDC analysis of National Vital Statistics
System (NVSS) mortality data, suicide rates among middleaged adults in the U.S. have increased over the last decade.
Eating Disorders
From 1999 to 2010, the age-adjusted suicide rate for adults
Suicide
aged 35–64 years in the U.S. increased by 28.4%, from 13.7
per 100,000 population to 17.6. In Connecticut, the age-adjusted rate grew 30.5%, faster than that of the U.S. as a
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whole, to 14.5 per 100,000 population.
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February 2014
In the state of Connecticut between 2005 and 2010, suicide was third leading cause of death among 20-24 yearolds, the second leading cause of death among 25-34 year-olds and the fourth leading cause of death among 35-44
110
111
and 45-54 year-olds. In 2002, Fairfield County saw 42 suicides, a rate of 6.35 per 10,000 residents. Over a fifth
(167) of the 812 suicides in Connecticut between 2002 and 2004 came from Fairfield County. Only New Haven
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(200, 25%) and Hartford (208, 26%) Counties had more suicides. The Southwest Region shows a significantly
higher rate of alcohol-related suicides of 6.4 compared to the State rate of 1.50 based on a per 10,000
113
population.
People with certain psychiatric illnesses are more likely to commit suicide than others. For example, 10% of those
with Borderline Personality Disorder (BPD) commit suicide and 33% of youth who commit suicide have features, or
traits, of BPD. This figure is 400 times higher than the general population, and young women with BPD have a
114
suicide rate of 800 times higher than the general population.
It is worth noting that although suicide in the elderly is an issue nationwide, residents of Connecticut seem to be
less affected by this trend.
SPOTLIGHT ON UNDERSERVED POPULATION: ADOLESCENTS AND HISPANIC YOUTH
Although not a Leading Health Indicator, one of the government’s mental health goals for 2020 is to reduce
115
suicide attempts by adolescents (MHMD-2) from 1.9 per 100 in 2009 to 1.7 per 100 people.
In the state of Connecticut between 2005 and 2010, suicide was the third leading cause of death among
116
adolescents aged 10-14 and the second leading cause of death among adolescents aged 15-19.
According to the YRBS 2011 data on suicidal behavior:


th
th
14.6% of 9 -12 graders in Connecticut seriously considered attempting suicide in the 12 months before
the survey, compared to 15.6% in the U.S. as a whole.
6.7% made at least one actual attempt, compared with 7.8% in the U.S. as a whole.
The Connecticut rates were higher for girls (17.3% considered and 8.2% attempted) as well as for all Hispanic
youth (17.1% considered and 11.0% attempted). This pattern is similar to the U.S. rates overall, where 19.3% of
117
girls considered and 9.8% attempted, while among Hispanics, 16.7% considered and 13.5% attempted.
According to the Latin Policy Institute, twice as many Latina teenagers in Connecticut (21%) attempt suicide as
118
African American (11%) or non-Latino white (10%) teenage girls.
Self-injury is also a concern among the adolescent population. The 2011 Connecticut School Health Survey (Youth
Behavior Component Report) found that “in Connecticut, 16.1% of high school students purposely hurt themselves
without wanting to die (i.e., self-injury) one or more times during the 12 months before the survey. The prevalence
of self-injury is significantly higher among female (21.6%) than among male (10.7%) students; and significantly
119
higher among white (16.3%) and Hispanic (20.5%) than among black (9.6%) students.”
Fairfield County has seen its fair share of adolescent suicides. In fact, there were three teen suicides in the first
month of the 2013 school year in Stamford, Stratford and Greenwich, where, a 15-year-old boy killed himself on
120
the first day of school, allegedly after pressure from “bullying.” Several students in Ridgefield have also taken
27
February 2014
121
their own lives in recent years, which spurred the creation of the organization Project Resilience, which seeks to
122
encourage the development of programs that address growth and resilience in children and adolescents.
DUAL DIAGNOSES
Dual diagnoses are far from uncommon. CASAColumbia found
in 2012 that 39.4% of non-institutionalized individuals aged
18 and older with addiction met clinical criteria for a mental
health disorder. Conversely, among those aged 18 and older
who have a mental health disorder, 30.6% are risky substance
123
users and 31.4% have addiction.
“Attention deficit/hyperactivity disorder and conduct disorder
are the most common co-occurring mental health disorders in
young patients being treated for addiction,” the report noted,
“and anxiety and depression are the most common cooccurring mental health disorders in older patients; trauma124
related disorders are common across age groups.”
Populations
Issues
General
Adolescents
Women
Hispanics
Seniors
Substance Abuse
Alcohol
Drugs
Tobacco
Mental Health
Mood & Anxiety
Disorders
Psychotic
Disorders
Eating Disorders
Suicide
In the course of conversations with experts across the field, we spoke with David Ockert, Ph.D., the Executive
Director of New York’s Parallax Center, a highly successful provider of outpatient detoxification services for opioid,
alcohol and benzodiazepine addictions. Dr. Ockert says that he has never seen a substance abuser walk through his
door without having some kind of co-occurring psychiatric condition, whether it be depression, anxiety or
something potentially more serious like bipolar disorder.
About two thirds of people who enter a psychiatric hospital or drug rehab have a co-occurring or dual disorder,
either a substance abuse problem with an associated psychiatric disorder or the other way around. Very often, the
associated disorder is not recognized by the patient and not identified by the facility. This makes full recovery less
likely. At Silver Hill Hospital we put a lot of effort into identifying these co-occurring or dual problems and treating
them concurrently.
The availability of centers such as Silver Hill Hospital that can handle multiple, co-occurring mental health and
substance abuse issues is critical. The National Alliance for Mental Illness (NAMI) says it best:
Despite much research that supports its success, integrated treatment is still not
made widely available to consumers. Those who struggle both with serious mental
illness and substance abuse face problems of enormous proportions. Mental health
services tend not to be well prepared to deal with patients having both afflictions….
Fragmented and uncoordinated services create a service gap for persons with cooccurring disorders…. Effective integrated treatment consists of the same health
professionals, working in one setting, providing appropriate treatment for both
125
mental health and substance abuse in a coordinated fashion.
28
February 2014
In FY 2013, over two-thirds of inpatients came to Silver Hill Hospital with a dual diagnosis: a primary diagnosis of
substance abuse with an associated psychiatric or eating disorder or a primary diagnosis of a psychiatric disorder
plus a secondary diagnosis of a chemical dependency. This figure is representative of what we see on the
transitional living program (residential) side, as well.
According to the 2011 NSDUH, 3.4% of the U.S. adult (ages 18+) population has a co-occurring disorder. For young
adults aged 18-25, that figure increases to 8.9%. In the Northeast, the figure is slightly higher than that of the U.S.
126
at 3.6%. Of adults who are dependent or abuse alcohol or illicit drugs, the study found 42.3% have a cooccurring mental illness. Conversely, of adults with any mental illness, 17.5% are dependent on or abuse alcohol or
127
illicit drugs versus 5.8% for the non-mentally ill population. The 2011 survey also found that for adults (aged
18+) with a major depressive episode (MDE) in the last year, 20.0% were dependent on or abused drugs or alcohol
128
compared to 7.3% of the population without an MDE in the last year. Among those with Borderline Personality
129
Disorder (BPD), about 35% have substance abuse issues and 25% have one or more eating disorders.
Many people associate co-occurring substance abuse and mental disorders with urban life. But a study conducted
in London demonstrated that “the prevalence of substance misuse in patients with severe mental disorders in a
130
suburban area is about as high as that for similar patients in inner-city London.” This finding certainly
resonates in suburban and small urban Fairfield County.
SPOTLIGHT ON UNDERSERVED POPULATION: YOUNG ADULTS AND WOMEN
With dual disorders, young adults and women again take center stage. Of young adults aged 18-25 with a mental
illness -- be it mild, moderate or severe – a full 30% are dependent on or abuse alcohol or illicit drugs compared to
13.7% for the non-mentally ill population. For mentally ill women in that age group, the rate is 37.0% (compared to
17.8% in the non-mentally ill population) versus 25.1% of mentally ill young men (compared to 8.9% of the non131
mentally ill population).
Adolescents also suffer from dual disorders. Of the 12-17 year-olds with a major depressive episode (MDE) in the
last year, 18.2% were dependent on or abused alcohol or illicit drugs, compared to 5.8% of the same cohort
without an MDE. Those figures are only slightly lower than the 20.0% and 7.3%, respectively, for adults aged 18
132
and over.
29
February 2014
COMMUNITY INPUT AND EXISTING RESOURCES
We interviewed several community experts and stakeholders (see section above in the introduction for the names
and bios of the people with whom we spoke). Several themes emerged from our conversations.
THEMES FROM COMMUNITY INPUT
FRAGMENTED, INSUFFICIENT PRIVATE SECTOR MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Several people we spoke to, including Dan Wartenberg, CEO of the Southwest Connecticut Mental Health System
(SWCMHS), the local mental health authority for DMHAS; Kate Mattias, Executive Director for the Connecticut
NAMI organization; Linda Autore, CEO of Laurel House; and Margaret Watt, Executive Director of the Southwest
Regional Mental Health Board (SWRMHB), offer counter-intuitive feedback. People on public assistance, they say,
often have more and better services than those available to people with insurance. The state system offers wraparound services focused on the full continuum of care, housing, supported employment services and supported
education services as well as peer services, which provide credible mentors to those suffering from mental illness.
There are no corollaries in the private sector. Despite the negative view many hold of the public sector’s programs
to address mental health needs, there is something we, as a private-sector provider to a mostly well-off patient
population, can learn from public assistance programs.
Ms. Mattias says that the mental health system for youth is “extremely fragmented.” Children with mental illness
receive support and services through the Connecticut Department of Children and Families (DCF). When they turn
18, however, they are no longer eligible for these services and must turn instead to the Department of Mental
Health and Addiction Services (DMHAS). Ms. Watt also acknowledges that the transition from DCF to DMHAS can
be arbitrary and unhelpful at times.
For adults, the system is less fragmented, Ms. Mattias says, but the approach to mental health is not as long-term
or holistic as it should be. The mental health system is “founded on episodic care,” she says, while what is needed
is a philosophy of “recovery” along a care continuum, much like the Medical Home and Accountable Care
Organization models are providing for general healthcare.
Peter Case, former President of the NAMI affiliate in Stamford/Greenwich echoes the need for a continuum care in
the mental health community. “Half of psychiatric inpatients discharged from hospitals in Connecticut” he says,
“never make it to outpatient care.” Complicating that situation is the fact that there are not enough affordable
case management services in the community. Places like the Dubois Center in Stamford (and others in the region)
do not accept patients who have insurance, even Medicaid, adds Lorraine Zegibe, head of Community Outreach for
Stamford/Greenwich NAMI. Ms. Watt agrees that the lack of case management services compounds users’
inability to navigate the system effectively.
Also contributing to the ineffectiveness and fragmentation of the system is the lack of housing options (e.g., group
homes, supervised apartments, sober housing), which inhibits a successful transition into community-based
recovery services.
30
February 2014
GAP IN SERVICES FOR YOUNG ADULTS
The data we reviewed suggest a gap in age-appropriate services (both mental health and substance abuse) for
young adults (ages 18-25), and the community stakeholders we interviewed agree.
Ms. Autore notes an increasing number of young adults with serious psychiatric illnesses who have, up until now,
been living in their parents’ houses without work or support services. Because Fairfield County is an affluent
community, many parents have the means to support their adult children, who at one point might have been
heading to Harvard or Cornell before their first psychotic break. Such individuals are not eligible for existing public
support services. So while personal funds are available, there simply aren’t enough programs geared toward
helping such individuals with psychiatric illnesses become productive members of society, resulting in what Ms.
Autore characterizes as “an enormous pent-up demand.”
Dr. Alan Barry, Commissioner of Social Services for Greenwich, corroborates Ms. Autore’s experience. Young adults
living with a psychiatric illness in their affluent parents’ homes, is a “really difficult population.” There is a lot of
denial, Dr. Barry says. Some small support programs exist, but they are not well attended. It is necessary to find
problem cases by going to other referral sources like NAMI or hospitals in the region, and then having social
workers contact the families. The families, unfortunately, are reluctant to participate due to the stigma associated
with schizophrenia and other psychiatric illnesses. Stigma is the biggest barrier to reeducating and reengaging that
population.
Ms. Mattias explains that this generation of young adults does not identify with the adults they see in the public
mental health system. Instead, they see themselves as having a chronic condition that is manageable, much like
any other chronic condition. As a result, young adults drop out of the system but cannot find equivalent services in
the private sector. Under the Affordable Care Act, young adults may still be covered for certain mental health
services, but not everyone is aware of the new law’s rules.
Mr. Case notes that “despite a recent good start by the Greenwich Department of Social Services and efforts by
Laurel House, we still lack enough young adult psychosocial programs” in the lower part of Fairfield County. Some
programs do exist in Bridgeport, however.
Ms. Watt also noted the unofficial young adult drop-in program being started by the Department of Social Services
and the YMCA in Greenwich as well as the more official Young Adult Services program being held at the Dubois
Center in Stamford. But she highlights the “huge issue” of the gap in such services. She suggests one area where
Silver Hill can get involved is in setting up or co-sponsoring a drop-in program for young adults in the New
Canaan/Darien/Wilton area.
DMHAS and the Southwest Regional Mental Health Board are also collaborating on a new Young Adult technology
initiative that will offer an online users’ guide to services such as self-screening, provider resources, understanding
insurance and so on. They are hoping to partner with colleges and private providers in the area starting summer
2014.
31
February 2014
PRIMACY OF ADULT SUBSTANCE ABUSE IN THE COMMUNITY
The secondary data we reviewed in previous sections show that substance abuse is a big issue in Fairfield County,
particularly alcohol, with opioid-based pain medications a close second.
Ingrid Gillespie, Director of the Lower Fairfield County Regional Action Committee, notes that the region has
mimicked national trends when it comes to the increasing use of marijuana and prescription drugs, while alcohol
continues to be a huge issue, particularly for the affluent white male population. But, she says, there has been a
notable increase in the use of heroin in lower Fairfield County (Stamford, Greenwich), at increasingly younger ages.
Whereas heroin addiction was once seen more often among people in their 20s and 30s, agencies and clinicians
are now seeing addicts as young as 18. The availability of prescription opioids has led to this increase in heroin use,
which is cheaper for addicts.
Barbara Greenberg, Ph.D., a clinical psychologist who lives in Weston, sees a lot of middle-aged women dealing
with substance abuse and depression as a result of what she calls “transitions of life”: divorce, empty nest
syndrome, menopause and so on. She sees “disconnection” in these women: husbands who work late, older
children who have their own lives or who no longer live at home, subtle competition with other women in the
community. As a result, they turn to alcohol, marijuana and off-label pain killers to deal with their reality.
Jacqueline D’Louhy and Kate Boyle for the Town of New Canaan Department of Youth and Family Services agree.
They see mothers who are binge-drinking (which they call having “mommy juice”), inadvertently modeling
dysfunctional drinking behavior for their children and adolescents.
At our Chronic Pain Recovery Center (CPRC) Open Forum in May 2013, 13 community providers, practice managers
and Connecticut State Drug Control officers came together to discuss the issue of addiction to pain medication as a
result of chronic pain. Many internists in the area do not feel comfortable or qualified to deal with these issues
since they have no real training in chronic pain. (This corroborates the aforementioned CASAColumbia study.)
There is also a need for patient and family education. Dr. Maria Di Giovanni, a pain specialist in Stamford, suggests
that Silver Hill Hospital host an open forum for patients and families to attend anonymously for information, with
no additional commitment required. Again, stigma plays a large role in access to services.
The State Drug Control staff discussed its Connecticut Prescription Monitoring and Reporting System (CPMRS)
133
website that is available for clinicians to review patient drug history and report issues. The prescription
monitoring program collects prescription data for Schedule II through Schedule V drugs into a central database,
which can then be used by providers and pharmacists in the active treatment of their patients. The purpose of
the CPMRS is to present a complete picture of a patient’s controlled substance use, including prescriptions by
other providers, so that the provider can properly manage the patient’s treatment, which may be the referral of a
patient to services offering treatment for drug abuse or addiction when appropriate.
As an institution, we believe a tri-state registry would be even more effective in assisting providers and preventing
“doctor shopping,” or obtaining prescriptions from multiple providers. Because our community is bordered by New
York State and is a one-hour car drive from Massachusetts and New Jersey, individuals currently have multiple
opportunities to circumvent the CPMRS.
32
February 2014
COMPLEX SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES FOR ADOLESCENTS
The adolescent population was mentioned independently by almost everyone with whom we spoke. The highpressure, high-stakes environment of our mostly affluent community contributes to pathological behavior by
adolescents because, as Mr. Wartenberg notes, “stress has a kindling effect.” Indeed, there were three teen
suicides in Fairfield County during the first month of the 2013-2014 school year alone.
We know from our own admissions department that requests for adolescent outpatient programming is one of the
biggest reasons we are forced to refer callers elsewhere. Dr. Aaron Krasner, a psychiatrist specializing in children,
adolescents and families, whom we hired recently to help revamp our Adolescent Transitional Living Program, also
says that there are very few providers who are comfortable with and capable of treating adolescents. There is
often nowhere for these patients to turn.
Dr. Barry maintains “we’re not getting to [adolescents] early enough.” He recommends prevention and early
intervention, i.e., approaching children in elementary and middle school, because high school is most likely too
late. Direct education on the ills of drug and alcohol abuse is important, but just as critical is indirect education,
“helping [kids] with judgment and decision-making.”
Ms. D’Louhy and Ms. Burke stress that integrating with already-existing community programs would be key to
reaching adolescents. The stigma associated with ‘going to the hospital,’ even for an outpatient program, is often a
deterrent to adolescents and their parents.
Substance Abuse
“We need to have far, outreaching educational arms to parents on the facts…and the risks” of substance abuse,
says Ms. Gillespie. Parents, she says, do not know about or understand the new research about the deleterious
effects of substance use on developing brains. Parents’ understanding the facts and legal implications is critical to
changing use patterns among adolescents in Fairfield County. Marijuana, prescription opioids and other drugs such
as PCP and “Molly,” a pure form of MDMA (ecstasy), have joined alcohol in the hands of increasingly younger
adolescents.
Dr. Greenberg says adolescent boys in our community tend to use marijuana starting at the end of middle school
as a way to cope with the anxiety prevalent in their high-pressure worlds. Dr. Greenberg sees boys who use
marijuana every day of the week, or only smoke it alone to relax. What is worse, they seem to believe that they are
better drivers when under the influence of marijuana, even though studies have shown that marijuana reduces
physical reaction times. She confirms that marijuana has lost the stigma it had as recently as ten years ago, which
is contributing to the increase in use, although she maintains that the root cause of the drug use for these teen
boys is anxiety disorders.
Awareness is important. Dr. Greenberg currently makes many presentations in the community. But even more
critical is creating a forum where community members can discuss these issues that often get swept under the
proverbial carpet. We live in a time of more digital communication than ever, but that hasn’t, she says, translated
into more actual communication about feelings and hardships. If anything, she says, it has decreased the amount
of true social connection we have with one another.
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February 2014
Unfortunately, parents in the community are also enabling -- even doing drugs with -- their children, including
marijuana and cocaine, which some women and their daughters use to lose weight or maintain weight loss. Some
parents are also turning a blind eye to drinking when children are out of their “dry season,” or the time they are
playing their most competitive sports. There is a lot of pressure on children to be perfect, and parents see drinking
during the off season as a way to let their children blow off steam.
While drugs remain taboo, marijuana has gained acceptance among both teens and adults, particularly since its
legalization. There is “definitely a misperception among youth and parents,” says Ms. Boyle with regard to the
ways in which medically prescribed marijuana is different than buying a few ounces from a local dealer. Marijuana
today is much stronger than that smoked by adults when they were in their youth, and there have been instances
of marijuana being laced with heroin or PCP. There is a great need for education on the dangers of marijuana,
especially for adolescents.
Claudette Kunkes, Ph.D., a psychologist in private practice in Fairfield County, confirms that the rising use of ecigarettes among adolescents is a concern being raised by her clients, who are mostly adult women in the area. Dr.
Greenberg agrees she has seen a rise in the use of e-cigarettes, although she is not convinced it will become a
trend for this community.
Mental Health
Adolescents suffering from depression or anxiety often turn to cutting themselves or eating disorders for girls, or
“things get swept under the rug” by boys, says Dr. Barry, who then may turn violent against themselves or their
classmates. The local Kids in Crisis Program has been embedding full-time counselors in schools in Stamford and
134
Greenwich to try to catch some of these children before they do harm to themselves or others. Ms. Gillespie
agrees that embedding counselors in the schools goes a long way towards facilitating a “warm hand-off” to youth
in crisis.
Dr. Greenberg agrees that girls are more likely to suffer from depression, eating disorders and self-mutilation –
which has seen a huge increase over the last ten years – and boys are more likely to act on their anxiety by using
drugs or turning violent. Children in the upper class world of Fairfield County, she says, are under enormous
pressure over schools and athletic achievement. The competition in the community is fueled by social media,
which studies have begun to show affect users’ self-esteem.
Complicating matters is the fact that parents, Ms. Mattias says, are lost when it comes to their post-diagnosis
children. Consequently, there is a need for support groups that would empower parents to be better able to help
their children.
Dr. Greenberg attributes the recent spate of suicides (in Greenwich, Stamford, Ridgefield and elsewhere) not to an
increase in bullying per se, but to an increase in its pervasiveness. With the advent of social media, bullying
“follows you to your home,” she says. Adolescents can’t get a break from the feeling of being persecuted, which
can be overwhelming. Ms. D’Louhy and Ms. Burke mentioned the same issue. Ingrid Pasten of the Center for
Sexual Assault Crisis Counseling and Education (which serves Darien, Greenwich, New Canaan, Norwalk, Stamford,
Westport, Weston and Wilton) says that ‘sexting’ is becoming a big issue and a trigger for teens who are
34
February 2014
considering suicide. Although the laws concern sexting are becoming harsher, she expects the issue to continue.
Mr. Wartenberg agrees the community could use more suicide prevention in the schools.
The level of stress and perfectionism is high in Fairfield’s affluent communities. Several individuals suggested both
facilitated meetings and presentations for parents and adolescents as well as professional development and
training for guidance counselors and school psychologists in both the public and private schools.
A “DEARTH” OF RESOURCES FOR EATING DISORDERS
Erin Kleifield, Ph.D. is a clinical psychologist in private practice in New York who lives, however, in Fairfield County.
She is working closely with Silver Hill Hospital on revamping its existing eating disorder services. She notes that
there is a “dearth” of existing services in the community. In particular, the “school systems are sorely lacking.” The
first step in remedying the absence of services is to promote awareness for families, providers and school
administrators on what to look for with regard to eating disorders, how to assess the situation and where to refer
individuals who need help. Mr. Wartenberg agrees that eating disorders are a “real issue,” and that there is a “lack
of expertise” in the region for dealing with these illnesses, both in the inpatient and outpatient settings.
Insight, Dr. Kleifield says, is not sufficient to help those who suffer from eating disorders. Practicing the skills of
healthy living is just as important, which is why it is critical that we develop more resources in the community for
addressing these disorders.
Dr. Greenberg also works with a lot of women and adolescents in the community. The rate of eating disorders she
sees in young girls has been stable over time. However, she has seen a recent increase over the past decade of
eating disorders in young men as well as post-menopausal women. Although it would be too speculative to come
up with a reason for such increases, Dr. Greenberg cites sports (like wrestling) and body image messages for boys
and the social isolation and sense of disconnection women in the community feel during this time of “transition”
(kids off to college, menopause, possible divorces). Dr. Kleifield notes that, increasingly, eating disorders are not
limited to girls; body image issues are cropping up for boys, too, evidenced by their “sending around pictures of
their six packs.”
There is a lot of pressure in Fairfield County’s upper class milieu to be perfect: raise the perfect children, look
perfect, have the perfect home. This pressure translates into substance abuse, anxiety and depression, as we have
discussed, but also into eating disorders. Both Ms. Watt and Ms. Gillespie agree eating disorders are a “big issue”
for both teens and mothers.
POCKETS OF UNDERSERVED COMMUNITIES EXIST
Senior Citizens
The Senior (ages 65+) community makes up 13.7% of Fairfield County’s population, slightly lower than Connecticut
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as a whole (14.4%) and slightly higher than the U.S. as a whole (13.3%). According to the University of
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Connecticut, however, the percentage of seniors in Fairfield County is expected to increase to 19% by 2030.
Mr. Wartenberg says there are “many isolated or homebound seniors with real mental health needs.” Many times
serious depression is confused with “senility” in senior citizens. People need to recognize that the elderly suffer
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February 2014
from depression and anxiety, too. He recommends screening days to help raise awareness. Ms. Zegibe agrees that
seniors, especially those with mental illness, tend to “isolate,” which can exacerbate symptoms and land them in
the hospital. Transportation is one of the biggest issues with this population, who are in dire need of case
management outreach services.
Ms. Watt agrees says the seniors who do not attend senior centers are often those most in need of help. The issue
is identifying and reaching them. The newly created State Department on Aging’s Older Adult Behavioral Health
Workgroup has a couple of outreach programs in the works, one for mental health and one for substance abuse.
Melba Neville, RN, the Seniors Outreach Coordinator for the Town of New Canaan, maintains that substance abuse
issues among seniors are swept “under the carpet.” In addition, there is an “assumption that older people don’t
get depressed,” which is clearly erroneous. Because their lifestyles change sometimes abruptly when they retire,
they can easily become isolated, and some then resort to drinking. Mixing alcohol with the multiple medications
seniors are often on and the decreased ability to process alcohol as one ages combine to create a true issue.
Bill Piper, Chief Executive Officer of the Waveny Care Network, which provides a continuum of care to older adults,
agrees that substance abuse – particularly of alcohol – in the senior population is a “huge” issue. He also believes
seniors might benefit from a senior-specific intensive outpatient program at SHH. Partnering on educational
programs with Waveny, the Lapham Center, Staying Put in New Canaan and the local YMCAs would be a great way
to reach senior citizens and their families.
Many interviewees agree that programs for seniors would do much better out in the community than on Silver Hill
Hospital’s grounds, since the stigma associated with going to a program ‘at the hospital’ might prevent people
from attending. Ms. Watt suggests holding programs in the community and targeting adults who are part of the
“sandwich generation,” taking care of both their aging parents and growing children.
Children
There are very few psychiatric services for children under the age of 13. The only inpatient program in the
community is St. Vincent’s in Westport. Mr. Case notes that there are no intensive outpatient programs for young
children in the lower part of Fairfield County, either. (There is a program at Danbury Hospital.) Dr. Krasner also
confirms that there are very few child psychiatrists in the community because it is such a tough patient population
with which to deal.
Minorities
“The Latino community [in Fairfield] continues to grow,” says Ms. Gillespie. In fact, the Hispanic community makes
up 17.4% of Fairfield County’s population, much higher than Connecticut as a whole (13.8%) and slightly higher
than the U.S. as a whole (16.7%). Even more telling is the fact that 20% of the county is foreign-born (compared to
13% in Connecticut and the U.S. as a whole) and 28% speaks a language other than English at home (compared to
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20% in Connecticut and the U.S. as a whole). According to the University of Connecticut, by 2030, the household
population of Fairfield County is expected to be 20% Hispanic. The African American population is expected to hold
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steady at 12%.
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February 2014
Mr. Case and Ms. Zegibe have been frustrated at how difficult it can be to get African American, Hispanic and
Haitian American individuals to seek out services. Although the need is great, there is a tremendous amount of
stigma in these communities about accepting help for mental health and substance abuse issues. NAMI has had
most of its success working through local community churches. The Lower Fairfield County Regional Action
Committee has also had some success working through churches and local bodegas. Their experience corroborates
the American Psychiatric Association report on barriers to access for Hispanics detailed earlier in the assessment.
Ms. Gillespie emphasizes the importance of providers and agencies meeting the population where they physically
are, as opposed to having them rely on transportation, to which many Latinos do not have access.
Ms. Watt expresses frustration at the lack of Spanish-speaking and Creole-speaking providers for the Hispanic and
Haitian American communities, respectively. Ms. Gillespie also notes the need for bilingual clinicians who can do
outreach to the community. Oddly, though, in SWRMHB’s August 2012 needs assessment, language was very low
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on the list of barriers for both mental health and substance abuse services.
PREVALENCE OF DUAL DIAGNOSES
According to Dr. Barry, co-occurring substance abuse and mental illness is one of the biggest problems facing our
community. There are a lot of people with depression and anxiety, he says, who are “undiagnosed or untreated”
and who are “masking it with alcohol.” And, as Ms. Gillespie points out, mental health and substance abuse issues
are risk factors for each other.
Mr. Wartenberg agrees there is a “significant gap with co-occurring issues,” particularly for adults, whom his
organization treats. The Southwest Connecticut Mental Health System (SWCMHS) sees many people with a
primary diagnosis of substance abuse and a secondary diagnosis of depression. “Substance abuse providers are
short on psychiatry time,” he says, because there is a real shortage of psychiatrists who want to work with the
dually diagnosed population.
The issue of dual diagnoses, however, does not pertain only to depression and anxiety. Ms. Autore stresses that
substance abuse – from tobacco to illicit drugs – is a “major, major problem” for the schizophrenic population.
Indeed, marijuana use is associated with the onset of psychotic disorders such as schizophrenia, particularly in
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individuals with an underlying vulnerability to the illness. Dr. Kleifield also notes the issue of eating disorders as
secondary diagnoses which sometimes rise to the surface during treatment for substance abuse.
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February 2014
EXISTING RESOURCES IN THE COMMUNITY
Fairfield County is fortunate to have a variety of existing resources available to residents of the community. Below
we have outlined the major categories.
PUBLIC HEALTH DEPARTMENTS
The Connecticut Department of Mental Health and Addiction Services (DMHAS) is our dedicated public health
department. The state is divided into five regions. Region 1 encompasses Southwest Connecticut, most of which is
Fairfield County.
The Connecticut Department of Children and Families (DCF) also runs a program called Care Coordination in
Norwalk, Stamford, Bridgeport and Danbury. Care Coordination works with children who have complex behavioral
health needs and who are at risk to be, or have already been, separated from their family and/or community for
the primary purpose of receiving behavioral health or related services.
The Connecticut Department of Public Health (DPH) is more focused on physical health issues.
Local Mental Health Authorities in Region 1
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Southwest CT Mental Health System (Bridgeport): DMHAS administrative office for Region 1.
F.S. Dubois Center (Stamford): The Community Services Division (CSD) in Stamford is located at the
Franklin S. Dubois Center (FSDC) and serves the greater Stamford/Norwalk area. FSDC is responsible for
providing ongoing, individualized treatment to persons living in the community with severe behavioral
health disorders who are publicly insured, uninsured and in some cases underinsured.
Greater Bridgeport Community Mental Health Center (Bridgeport)
HOSPITALS
Adult Psychiatric Inpatient Departments
In addition to Silver Hill Hospital, there are six private hospitals with inpatient and/or emergency psychiatric
services as well as the public health system in Bridgeport.
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Bridgeport Hospital (Bridgeport): Offers inpatient treatment and care for adults in need of hospitalization
because of an acute psychiatric illness. Geriatric Psychiatric Inpatient Program provides individualized care
and therapeutic groups and family assessments and family support services.
Danbury Hospital (Danbury): Inpatient psychiatric unit for adults.
Norwalk Hospital (Norwalk): Inpatient psychiatric unit for adults.
Saint Vincent’s Behavioral Health (Westport): Acute inpatient treatment for adults with mental health
needs. Adults with a dual diagnosis of mental illness and substance abuse are also treated.
Saint Vincent’s Medical Center (Bridgeport): Short-term inpatient care for adults in mental health crisis.
Silver Hill Hospital (New Canaan): Acute inpatient treatment for adults with mental health, substance
abuse and co-occurring disorders.
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Southwest Connecticut Mental Health System (Bridgeport): Inpatient psychiatric care for adults with cooccurring illnesses who have no insurance or who are unable to receive treatment at local hospitals.
People with insurance must present at other local hospitals first. Program incorporates both psychiatric
and substance abuse disorders into treatment. PICU 1 and 2 are locked psychiatric units providing
treatment for acutely ill psychiatric clients who require a safe, supportive and structured hospital level of
care. Program will assist with re-entry once the individual is ready to return to community-based living.
Stamford Hospital (Stamford): Offers hospital-based inpatient psychiatric care and consultation/liaison
services, behavioral disorder evaluation and treatment for addiction, anxiety and panic disorders, bipolar
disorder, dementia, depression, eating disorders, OCD, psychosis, and schizophrenia.
Adolescent Psychiatric Inpatient Departments
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Saint Vincent’s Behavioral Health (Westport): Inpatient treatment for children and adolescents ages 7-17
with acute psychiatric conditions, as well as a specialized program for patients with co-existing psychiatric
and substance abuse disorders.
Silver Hill Hospital (New Canaan): Acute inpatient treatment for adolescents ages 13-17.
Psychiatric Emergency Departments
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Bridgeport Hospital (Bridgeport)
Danbury Hospital (Danbury)
Greenwich Hospital (Greenwich)
Norwalk Hospital (Norwalk)
Saint Vincent’s Medical Center (Bridgeport)
Stamford Hospital (Stamford)
Hospital-Based Outpatient Mental Health and Substance Abuse Programs
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Bridgeport Hospital (Bridgeport): Resource For Adult And Child Mental Health (REACH) (Stratford):
Intensive Outpatient Program and Partial Hospital Program for adults ages 18+. Programs accept people
who have a dual diagnosis of substance abuse and mental illness. Older adults are placed in an Older
Adult Track designed specifically for those who are facing mental health issues due to aging.
Danbury Hospital (Danbury): Center For Child And Adolescent Treatment Services (Danbury): Offers
psychiatric and substance abuse assessments and intensive outpatient program for children ages 7-12
diagnosed with a psychiatric disorder. Dual Diagnosis Program for youth ages 13-18 with a psychiatric and
substance abuse diagnosis.
Greenwich Hospital (Greenwich): Addiction Recovery Center (Greenwich): Diagnostic assessment for
adults and substance abuse education/prevention. Recovery Program offers day and evening intensive
outpatient programs for those seeking treatment for alcohol and drug dependency.
Norwalk Hospital (Norwalk): Behavioral Health and Addiction Services | Assessment For Substance
Abuse/Mental Health Evaluation (Norwalk): Provides mental health evaluation and/or substance abuse
assessment for adults, individual and group counseling for patients abusing alcohol and drugs. Also
provides IOP, outpatient counseling, DBT therapy, etc.
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Saint Vincent's Behavioral Health Services (Bridgeport): The Center At Bridgeport Partial
Hospital/Intensive Outpatient Program Latino Program & Psychiatric Day Treatment Latino Program
(Bridgeport): Partial Hospital is designed to treat patients with acute psychiatric symptoms and diagnosed
substance abuse disorders. Program includes group therapy, individual and family therapy and medication
management. Intensive Outpatient Program is designed to treat patients with severe psychiatric
symptoms.
PRIVATE PHYSICIANS
Silver Hill Hospital maintains a database of nearly 1,600 providers in private or group practices that specialize in
mental health and/or substance abuse issues in Fairfield County and neighboring Litchfield County alone. The list
includes psychiatrists, psychologists, nurses, social workers, counselors, dietitians and non-psychiatrist physicians,
some of whom specialize in adolescent medicine.
COMMUNITY MENTAL HEALTH CENTERS
Fairfield County is fortunate to have in place several residential and community mental health centers. Below is a
sampling.
24-Hour Crisis Intervention Services
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Adults: F.S. Dubois Center (Stamford) and Greater Bridgeport Community Mental Health Center
(Bridgeport)
Children: Child Guidance of Southern CT (Stamford) and Child Guidance Center (Bridgeport)
Southwest Regional Mental Health Board
The Southwest Regional Mental Health Board is located in Norwalk. A citizens’ advisory council, created by State
mandate to assess and promote mental health and addiction services in Southwestern Connecticut. The Regional
Mental Health Board has four Catchment Area Councils (CACs) corresponding to different areas of the region. CAC
1 Serves the towns of Darien, Greenwich, New Canaan and Stamford; CAC 2 Serves the towns of Norwalk, Weston,
Westport and Wilton; CAC 3 Serves the towns of Bridgeport (western portion), Easton and Fairfield; CAC 4 Serves
the towns of Bridgeport (eastern portion), Monroe, Stratford and Trumbull.
DMHAS-Funded Mental Health Programs in Region 1
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Ability Beyond Disability (Bethel)
Applied Behavioral Rehabilitation Research Institute (Bridgeport)
Bridge House, Inc. (Bridgeport)
Catholic Charities of Fairfield County (Bridgeport)
Central Connecticut Coast YMCA (Bridgeport)
Chemical Abuse Service Agency, Inc. (Bridgeport)
Family & Children's Agency, Inc. (Norwalk)
Family Centers, Inc. (Stamford, Darien)
Family Services - Woodfield, Inc. (Bridgeport)
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Goodwill Industries of Western CT, Inc. (Bridgeport)
Hall Brooke Behavioral Health Services, Inc. (Westport)
Homes With Hope (Interfaith Housing Association) (Westport)
Inspirica Inc. (formerly St Luke's Community Services) (Stamford)
Kennedy Center, Inc. (Trumbull)
Keystone, Inc. (Norwalk)
Laurel House, Inc. (Stamford)
Marrakech Day Services, Inc. (Woodbridge)
Mental Health Association of CT, Inc. (Bridgeport/Stamford)
Micah Housing, Inc. (Fairfield)
The Open Door Shelter (Norwalk)
Operation Hope of Fairfield, Inc. (Fairfield)
Optimus Health Care, Inc. (Bridgeport)
Pathways, Inc. (Greenwich)
Recovery Network of Programs, Inc. (Shelton)
Shelter for the Homeless, Inc. (Stamford)
Southwestern Connecticut Agency on Aging, Inc. (Bridgeport)
Faith-Based Community Mental Health Programs
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Ark Community Residence And Counseling Center (Bridgeport): Spiritually based general counseling
provided to individuals and groups of women in Fairfield County, struggling with substance abuse and/or
mental health issues.
Catholic Charities (Norwalk, Stamford, Bridgeport): Variety of mental health evaluation and services.
Jewish Family Services (Bridgeport, Stamford, Westport): Counseling services.
Salvation Army (Norwalk): Christian-based pastoral counseling offered on a short term basis.
Other Community Mental Health Programs in Fairfield County
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Amedisys Home Health (Stamford, Stratford, Danbury): Provides in-home mental health nursing.
Child Guidance Center (Norwalk, Darien, Stamford, Greenwich, Fairfield, Bridgeport): Child abuse
treatment team provides interdisciplinary evaluation and treatment of physically and emotionally abused
children, siblings, and significant non-offending adults in the family. Offers 24-hour crisis intervention and
immediate mental health assessment for children under age 19. Bilingual program. The clinic is
designated by the Connecticut Department of Children and Families
Connecticut Counseling Centers (Norwalk, Danbury): Substance abuse assessments and mental health
evaluations for adults. Mental health and substance abuse outpatient services include individual, couples,
family, and group counseling; psychiatric services; dual diagnosis program; and drug and alcohol urine
testing. All programs offer bilingual services. Accepts people with co-occurring mental and substance
abuse disorders.
Connecticut Renaissance (Norwalk, Stamford, Bridgeport): Adolescent and Family Behavioral Health
Program provides treatment for adolescent boys and girls ages 11-16 with mental health, behavioral and
substance abuse problems.
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February 2014
Constellation Home Care (Norwalk): Offers home-based behavioral health nursing.
Depression and Bipolar Support Alliance (Greenwich, Westport): Support groups for people with
depression/bipolar disorder and their family members.
Emotions Anonymous International (Georgetown, Bethel, Bridgeport): Support group for those
experiencing emotional difficulties.
Fairfield Counseling Services (Fairfield): Evaluation, psychopharmacology and treatment of anxiety
disorders, mood/depressive disorders, personality disorders, adjustment disorders, eating disorders, and
post-traumatic stress disorder.
Family and Children's Aid (FCA) Outpatient Psychiatric Enhanced Care Clinic For Children (Danbury):
Child guidance clinic for children, adolescents and their families provides a range of outpatient mental
health services including assessments and evaluations, counseling, psychiatric treatment,
psychopharmacology, and family counseling. Outpatient intervention for children ages 4-18 who have
significant behavioral and emotional problems that are related to traumatic life events, even if they do
not meet full diagnostic criteria for post-traumatic stress disorder (PTSD).
FSW Walk-In Mental Health Clinic (Bridgeport): Offers individual, couples, and family counseling for
children, youth, and adults on a walk-in basis.
Laurel House (Stamford): Provides resources and opportunities for people living with serious psychiatric
illnesses such as schizophrenia to lead fulfilling and productive lives in the communities where they live,
work and go to school.
Jewish Family Service (Stamford, Westport, Bridgeport): Mental health counseling for children ages 8+.
New England Home Care (Shelton): Offers home-based behavioral health services.
Project Resilience (Ridgefield): Seeks to encourage the development of programs that promote the social
and emotional growth and resilience of children and adolescents to seek to prevent suicides and other
tragedies.
Project Return (Westport): Residential, after-care and transitional living programs for adolescent girls.
Southwest Community Health Center (Bridgeport): Individual and family counseling for youth ages 10-18
with mental health needs. Individual, child, family, and group mental health counseling for anxiety,
depression, marital difficulties, family issues, and domestic violence.
The Center For Women and Families of Eastern Fairfield County (Fairfield, Bridgeport, Monroe): Crisis
counseling for victims of sexual assault.
Visiting Nurse Services Of Connecticut (Bridgeport, Trumbull): In-home psychiatric nursing care for
people with mental illness.
SUBSTANCE ABUSE TREATMENT AND RECOVERY PROVIDERS
Fairfield County is fortunate to have in place several substance abuse treatment and recovery providers. Below is a
sampling.
Region 1 Substance Abuse Action Councils
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Lower Fairfield County Regional Action Council (Stamford): Towns Served: Darien, Greenwich, New
Canaan, Stamford
Mid Fairfield Substance Abuse Coalition (Norwalk): Towns Served: Norwalk, Weston, Westport, Wilton
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Regional Youth/Adult Social Action Project (Bridgeport): Towns Served: Bridgeport, Easton, Fairfield,
Monroe, Stratford, Trumbull
DMHAS-Funded Substance Abuse Programs in Region 1
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Chemical Abuse Services Agency, Inc. (Bridgeport)
Connecticut Counseling Centers Inc. (Norwalk)
Connecticut Renaissance, Inc. (Bridgeport)
Council of Churches of Greater Bridgeport, Inc., Co-Op Center (Bridgeport)
Fairfield Counseling Services, Inc. (Fairfield)
Fairfield University Fairfield Corps Advisory (Fairfield)
Family & Children's Agency, Inc. (Norwalk)
Human Services Council of Mid-Fairfield (Norwalk)
Inspirica Inc. (formerly St Luke's Community Services) (Stamford)
Liberation Programs, Inc. (Norwalk, Bridgeport, Stamford)
Norwalk Economic Opportunity Now (NEON) (formerly CTE, Inc.) (Norwalk, Stamford)
Optimus Health Care, Inc. (Bridgeport)
Positive Directions The Center for Prevention and Recovery (Westport)
Recovery Network of Programs, Inc. (RNP) (Shelton)
RCS Annex/Regional Youth Adolescent Program Regional Youth/Adult Substance Abuse Project
(Bridgeport)
Stratford Partnerships For Success (PFS) (Stratford)
Trumbull Partnership Against Underage Drinking (TPAUD) (Trumbull)
Faith-Based Substance Abuse Programs
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ARK Community Residence And Counseling Center (Bridgeport): Spiritually based general counseling
provided to individuals and groups of women in Fairfield County, struggling with substance abuse and/or
mental health issues.
Ashe' Faith Project (Bridgeport): Provides substance abuse education and prevention to anyone in need.
Referrals to mental health and substance abuse providers are offered.
Basic House Outreach Ministries Christian Based Supportive Recovery Program (Norwalk): Christianbased sober homes and supportive living center for persons in crisis.
Bethel Recovery Center Christian Based Supportive Recovery Home (Bridgeport): Christian based
substance abuse supportive recovery home for women who are addicted to alcohol or other drugs.
Services include referral to social services, counseling, and life skills training. Length of stay is 6-24
months. The Center will accept women who are dually diagnosed.
Casa Recovery House (Bridgeport): Offers a three phase (up to 90 days) faith based residential program
for adult males recovering from substance abuse. Services include individual, group and family counseling,
educational classes, recreational therapy, case management, health services, and pastoral services.
Catholic Charities - Diocese Of Bridgeport (Danbury): Support group for people with a dual diagnosis of
substance abuse and mental health disorder.
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February 2014
Christian Community Outreach Ministries Discipleship House/New Covenant House (Danbury): Christian
based supportive recovery home for men and women ages 18+ who are recovering from substance abuse.
Includes 12 step model support groups and pastoral counseling to help residents stay in recovery.
Pivot Ministries Christian Based Residential Substance Abuse Treatment (Bridgeport, Norwalk): Pivot
Ministries is a 16 month, Christian based, residential rehabilitation program for men with a history of
substance abuse.
Other Substance Abuse Programs in Fairfield County
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APT Foundation Residential Substance Abuse Treatment for Adults (Bridgeport): Residential substance
abuse disorder treatment facility provides group therapy, psycho-educational groups, therapeutic leisure
activity groups, and NA/AA recovery meetings.
Barnum / Waltersville Family Resource Center (Bridgeport): Positive youth development activities and
after school programming include peer mentoring, conflict resolution, substance abuse prevention
programs, homework assistance and links to the City's Lighthouse Program.
Boys And Girls Club (Ridgefield, Bridgeport): Youth enrichment programs. Personal development activities
include counseling, tutoring, recreational, health, fitness, substance abuse programs, vocational
counseling and educational field trips. Smart Moves Program is a prevention program that helps young
people resist alcohol, tobacco and other drug use, as well as premature sexual activity.
Casa Hostos Program (Bridgeport): Offers an intensive (28 days) and intermediate (up to 6 months)
residential treatment program for Latino adults with alcohol, cocaine, crack, hallucinogen, heroin,
inhalant, and prescription medicine addictions. Intensive outpatient substance abuse treatment program
provides individual, group and family therapy.
Child and Family Guidance Center (Bridgeport, Fairfield, Stratford): Provides care for families who are
experiencing substance abuse and/or parent attachment issues with children. Program services includes
home-based, individual and group therapy. Outpatient adolescent substance abuse treatment provides
substance abuse treatment and evaluation services for adolescents who are at risk for substance abuse or
who are currently abusing.
Connecticut Community For Addiction Recovery (Bridgeport): CCAR holds monthly meetings at regional
locations around Connecticut to provide advocacy, organization and support for educating legislators,
policy makers, service providers and the general public about the addiction recovery process. Drop-in
recovery center offers a place to meet with others in recovery, computers for use in job searches, and
support groups for people in recovery and their families, including separate meetings for men and for
women.
Courage To Speak Foundation (Norwalk): Drug prevention education curriculum is provided to fourth,
fifth and sixth graders.
Danbury Youth Services (Danbury): Psychiatric clinic offers short- and long-term counseling for young
people and their families following individualized treatment plans. Counselors offer crisis intervention
support, extensive assessment services, substance abuse counseling, parenting skills assistance.
Double Trouble In Recovery (Bridgeport): Self-help organization follows the 12 step model in support
groups for people dually diagnosed with a substance abuse problem as well as a psychiatric disorder.
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Family and Children's Aid Extended Day Treatment For Youth (Danbury): Extended day treatment
program for high-risk youth ages 4-17. Offers group, individual and family counseling; alcohol and
substance abuse evaluation and treatment; health education.
Housatonic Valley Coalition Against Substance Abuse (HVCASA) (Bethel): Offers program development
for substance abuse prevention and treatment programs.
MCCA (Ridgefield, Bridgeport, Danbury): Individual, family and group substance abuse counseling.
New Canaan Cares (New Canaan): Offers presentations on health and wellness to community groups and
schools. Offers educational programs for students and parents addressing problems of substance abuse.
New Era Rehabilitation Center (Bridgeport): Provides a substance abuse assessment for adults.
Outpatient methadone maintenance treatment program provides detoxification services to adults ages
18+. Outpatient treatment for chemically dependent, substance abusing adults. Additional services
include individual and group counseling, drug screenings and medical monitoring. Pregnant/postpartum
women ages 18+ are also treated.
Newtown Parent Connection (Newtown): Grassroots organization promotes substance abuse prevention
and awareness among parents of children of all ages through public forums, workshops and support
groups.
Newtown Youth and Family Services (Sandy Hook): NYFS provides substance abuse counseling for the
Newtown School system. Counseling is provided in the schools.
Norwalk Youth Services Bureau Peer Outreach Program (Norwalk): Interactive prevention program open
and free to 7th and 8th grade students in the City of Norwalk. Group discussions on topics of interest to
teens include: Life Skills, Self-Awareness, Peer Relationships, Substance Abuse, Motivational Exercises and
Team Building Activities, etc.
Re-Al Club Substance Abuse Drop In Services (Stamford): Drop-in center for recovering alcoholics who
are members of the club. Membership is contingent on a 30-day probationary period.
Ridgefield Community Coalition Against Substance Abuse (RCCASA) (Ridgefield): Community resource
for Ridgefield residents facing drug and alcohol abuse issues. Offers educational programs for parents.
Roscco Family Resource Center (Stamford): Offers positive youth development services at a middle
school targeted at preventing teen pregnancies and substance abuse.
Southwest Community Health Center (Bridgeport): Chemical dependency evaluations for individuals who
have been referred from a variety of sources in the community. Intensive Outpatient Program (IOP) and
substance abuse day treatment and counseling offers substance abuse counseling services and a
comprehensive outpatient treatment program.
Stamford Counseling Center (Stamford): Relapse prevention counseling is offered for alcohol and drug
abuse recovery.
Stratford Community Services Stopping Underage Drinking In Stratford (SUDS) Coalition (Stratford):
Works to reduce underage drinking by raising community awareness of the problems associated with
underage drinking and limiting youth access to alcohol.
The Connection, Women's Recovery Support Program (Bridgeport): Substance abuse recovery and
supportive housing program for non-parenting women ages 18-30, with an emphasis on promoting selfesteem and personal development.
Wellmore Behavioral Health (Danbury): Provides care coordination for children ages 0-18 (or 21 if still
receiving services from a local educational authority) who have complex behavioral health needs.
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Wilton Youth Services Parent Connection (Wilton): Substance abuse education and prevention program.
EATING DISORDER RESOURCES
There are a very limited number of comprehensive programs in Fairfield County.
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The Renfrew Center (Old Greenwich): Offers day treatment, intensive outpatient program and other
outpatient services. Also offers a group therapy program for emotional eaters. Residential programs are
available at other locations.
Center for Discovery (Southport): Specializes in eating disorder residential treatment for male and female
adolescents, aged 11-17.
Wilkins Center (Greenwich): Outpatient center offering complete medical, nutritional and psychiatric
services for patients affected by eating disorders and their families.
There are also some eating disorder programs just beyond Fairfield County, including the Institute for Living at
Hartford Hospital and Walden Behavioral Care, both in Hartford County, and Wellspring in Bethlehem, Litchfield
County.
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PRIORITIZED HEALTH NEEDS OF OUR COMMUNITY
Based on the research and conversations in the preceding sections, we have determined the following priorities in
meeting community needs. We used three criteria for determining priorities:
1.
2.
3.
Urgency: How critical is the need? Is it a life and death situation, as issues of mental health and substance
abuse sometimes are?
Size: How big is the need? Does it affect a large swath of our community?
Capacity: How able are we, as a behavioral health institution, to address the need? Will we make an
impact?
In our research and conversations, we have found that community-based help is better than technical support.
Improving care for depression in low-income communities — places where such help is frequently unavailable or
hard to find — provides greater benefits to those in need when community groups such as churches and even
141
barber shops help lead the planning process, according to a brand new study from the RAND Corporation.
Dr. Alan Barry, Commissioner of Social Services in Greenwich, said it well when he told us, “the best thing Silver Hill
Hospital can do [is provide] a comprehensive continuum” of care as individuals step down the slope of acuity. Our
inpatient and transitional living programs are well entrenched in the community; we are now turning towards
enhancing our residential services and making our outpatient programming just as robust.
We elaborate on the following four priorities, including specific plans and timelines, in the Implementation Plan.




Priority One: Substance Abuse Programs for Adults
o Chronic Pain and Recovery Program
o Comprehensive Outpatient Substance Abuse Program, including outpatient detoxification
Priority Two: Enhanced Adolescent Programming
o Enhanced Adolescent Transitional Living Program
o Intensive Outpatient Program
Priority Three: Enhanced Eating Disorder Program
Priority Four: Community Liaison Position
o Outreach to underserved populations including youth and families, senior citizens and minorities
o Partnering with existing community programs
There are also some needs identified in this assessment that Silver Hill Hospital will not be addressing at this time.
These include:
Smoking Cessation. Although there is some concern for rates of tobacco use among minority populations, the
overall rate of smoking in Fairfield County is lower than the national average. The most recent sub-state data from
NSDUH (2008-2010) reported that 19.54% adults aged 12 and over in the Southwest Region smoked in the past
142
month, compared to 21.56% in Connecticut and 23.46% in the U.S. as a whole. None of our interviewees
mentioned cigarettes – even e-cigarettes – unless prompted, and even then, there was not a lot of concern.
47
February 2014
In addition, according to the Tobacco Use Prevention & Control Program in the Connecticut Department of Public
Health, there are already eight smoking cessation programs in Fairfield County: three in Bridgeport, one in
143
Danbury, one in Fairfield (town), one in Greenwich, one in Norwalk and one in Stamford.
Due to the relatively non-urgent and low need as well as the availability of services in the community, Silver Hill
Hospital does not feel its resources are best used developing smoking cessation programs.
Long-term Residential Care for Individuals with Serious Psychiatric Conditions. There is a great need for longterm residential programs for individuals with serious psychiatric conditions such as schizophrenia and
schizoaffective disorder. For some patients, Michael’s House – Silver Hill Hospital’s short-to-intermediate-term
residential program – is just what they need to transition from inpatient care to community living. Programs such
as Laurel House in Stamford and others are paving the way to help such individuals develop job and life skills that
will enable them to function in society.
Others will never be able to live in the community on their own. Places like Gould Farm in Monterey,
144
Massachusetts offer long-term residential therapeutic communities for individuals living with mental illness. At
this time, Silver Hill Hospital does not have the physical space or the staff to provide such a service.
Long-term Residential Care for Addicts. Another need in the community is for sober houses as identified by
145
DMHAS in its August 2012 report. Again, at this time, Silver Hill Hospital does not have the physical space or staff
to provide such a service.
Non-Emergent Evaluation Service for Adolescents. There are 75 school-based health centers (SBHCs) in
Connecticut. Four communities in Fairfield County, corresponding to the urban and low-income centers, have
SBHCs in their elementary, middle and high schools: Bridgeport (ten sites, sponsored by Optimus Health Care),
Norwalk (four sites, sponsored by the Human Services Council), Stamford (five sites serving seven schools,
sponsored by Family Centers, Inc.) and Stratford (one site, sponsored by the Stratford Health Department). These
clinics offer on-site medical and behavioral health services, health education and in some cases, dental services to
146
children and teens.
Other local agencies have added to this type of support. For example, the Kids in Crisis program in several
communities has begun placing full-time counselors in area high schools as part of its “TeenTalk” effort to help
adolescents with personal and family pressures.
We currently provide educational services to adolescents admitted as inpatients or residents in a Transitional
Living Program (TLP). In particular, we work with schools to conduct an in-depth educational assessment for all
adolescent TLP patients. The first step is to review the existing school assessments up until the point of admission.
Next, we offer a battery of screening and psychological testing to understand the patient’s needs. Finally, we
develop a detailed “educational roadmap” for the patient to complete appropriate schooling. We also include the
patient’s parent(s) in the roadmap. If needed, we refer patients to outside institutions for complete
neuropsychological testing, as appropriate.
There is a gap, however, between the counseling services schools can offer and the possible need for a greater
level of care (e.g., hospitalization, residential programs, etc.). Because schools do not have enough expertise at
48
February 2014
evaluating such a need, they often send potentially at-risk adolescents to general hospital emergency
departments, which do not have the bandwidth to deal with such patients.
In the future, Silver Hill Hospital may consider developing a non-emergent evaluation service for adolescents to fill
the gap between school-based programs and hospital admissions. At this time, however, we do not have the
staffing necessary to develop such a program. In the meantime, we plan to address the gap in community services
for adolescents (and others) through our new Community Liaison position, elaborated upon more fully in the
Implementation Plan.
49
February 2014
ENDNOTES
1
Kaiser Family Foundation, “Snapshots: Health Care Spending in the United States & Selected OECD Countries,”
April 12, 2011. http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-statesselected-oecd-countries/
2
John Wright, et al, “Development and importance of health needs assessment,” BMJ, 1998 April 25; 316(7140):
1310-1313. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113037/
3
2012 U.S. Census. http://quickfacts.census.gov/qfd/states/09000.html
4
U.S. Census, Bureau of Labor Statistics
5
http://assessment.communitycommons.org/CHNA/MapGallery.aspx
6
CDC, Behavioral Risk Factor Surveillance System, 2010 (1999-2006 data). USA includes States & DC.
7
The National Center on Addiction and Substance Abuse at Columbia University, “Addiction Medicine: Closing the
Gap Between Science and Practice,” June 2012, 133, 137.
http://www.casacolumbia.org/templates/publications_reports.aspx
8
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2010 and
2011 (2010 Data - Revised March 2012). Tables 10, 17, 18 and 23.
http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsae2011/NSDUHsaeStateTabsTOC2011.htm#TopOfPage
9
2011 (2010 Data - Revised March 2012). Table 21.
10
DMHAS Biennial Report, COLLECTION AND EVALUATION OF DATA RELATED TO SUBSTANCE USE, ABUSE, AND
ADDICTION PROGRAMS,” 2010 http://www.ct.gov/dmhas/lib/dmhas/opas/biennial2010.pdf
11
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health. Table 10
in the following surveys: 1) 2008 and 2009 (state); 2)2006, 2007 and 2008 (sub-state); 3) 2010 and 2011 (2010 Data
- Revised March 2012) (state); 4) 2008, 2009, and 2010 (Revised March 2012) (sub-state)
http://www.samhsa.gov/data/
12
Connecticut Department of Mental Health and Addiction Services (DMHAS) Sub-Region 1A Substance Abuse
Profile, 2008.
13
Connecticut Department of Mental Health and Addiction Services (DMHAS) Sub-Region 1C Substance Abuse
Profile, 2008.
50
14
February 2014
15
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health. Table 10
in the following surveys: 2008 and 2009 & 2010 and 2011 (2010 Data - Revised March 2012)
http://www.samhsa.gov/data/
16
CDC, Connecticut Youth Risk Behavior Survey 2011
http://apps.nccd.cdc.gov/youthonline/App/Results.aspx?LID=Connecticut
17
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008,
2009, and 2010 (Revised March 2012).Table 12.
http://www.samhsa.gov/data/NSDUH/substate2k10/ExcelTables/NSDUHsubstateExcelTabsTOC2010.htm
18
2009, and 2010 (Revised March 2012). Table 10.
19
Connecticut SPF-SIG State Epidemiological Workgroup (SEW)
http://commed.uchc.edu/healthservices/sew/default.htm, SPF-SIG Community Level Data Excel Spreadsheet
20
Profile, 2008.
21
NIH Senior Health http://nihseniorhealth.gov/alcoholuse/alcoholandaging/01.html
22
SAMHSA Data Spotlight, “Older Adult Substance Abuse Treatment Admissions Have Increased; Number of
Special Treatment Programs for This Population Has Decreased,” July 12, 2012
http://www.samhsa.gov/data/spotlight/WEB_SPOT_043/WEB_SPOT_043.pdf
23
24
25
http://www.samhsa.gov/data/NSDUH/substate2k08/Excel/NSDUHsubstateExcelTabsTOC2008.htm
26
SAMHSA Treatment Episode Data Set (TEDS) 2000 – 2010 State Admissions to Substance Abuse Treatment
Services, Table 3.7. http://www.samhsa.gov/data/2k13/TEDS2010/TEDS2010StTOC.htm
51
February 2014
27
28
29
http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsaeTOC2011.htm
30
Services, Table 1.6b. http://www.samhsa.gov/data/2k13/TEDS2010/TEDS2010StTOC.htm
31
32
Gap Between Science and Practice,” June 2012, 61.
33
34
35
36
37
DMHAS Biennial Report, Collection and Evaluation of Data Related to Substance Use, Abuse, and Addiction
Programs,” 2010 http://www.ct.gov/dmhas/lib/dmhas/opas/biennial2010.pdf
38
Gap Between Science and Practice,” June 2012, 207.
52
39
February 2014
DMHAS Region 1 Regional Priority Services Report, August 2012.
40
41
2009, and 2010 (Revised March 2012).Tables 2, 3, 4, 7 and 8.
42
43
The National Center on Addiction and Substance Abuse at Columbia University, “National Survey of American
Attitudes on Substance Abuse XVI: Teens and Parents,” August 2011, 17.
http://www.casacolumbia.org/upload/2011/20110824teensurveyreport.pdf
44
Crean et al., “An Evidence-Based Review of Acute and Long-Term Effects of Cannabis Use on Executive Cognitive
Functions,” Journal of Addiction Medicine: March 2011 - Volume 5 - Issue 1 - pp 1-8
45
46
47
2009 (Revised March 2012). Table 2.
http://www.samhsa.gov/data/NSDUH/2k09State/NSDUHsae2009/NSDUHsaeExcelTabsTOC-2009.htm
48
49
Profile, 2008.
50
CDC Vital Signs, “Prescription Painkiller Overdoses,” July 2013
http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/index.html
51
Population estimates from 2007-2011 American Community Survey 5-Year Estimate of the U.S. Census Bureau
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
53
February 2014
52
53
54
http://www.ct.gov/dmhas/lib/dmhas/prevention/ctspf/SEWprofiles09.pdf
55
Kaiser Family Foundation State Health Facts http://kff.org/statedata/
56
CDC, Behavioral Risk Factor Surveillance System, 2010 (1999-2006 data). USA includes States & DC.
57
County Health Ratings and Roadmaps, 2005-2011 data
http://www.countyhealthrankings.org/app/connecticut/2013/fairfield/county/outcomes/overall/snapshot/byrank
58
59
60
CDC, Connecticut Youth Behavior Risk Survey 2011
61
62
CDC Morbidity and Mortality Weekly Report, “Notes from the Field: Electronic Cigarette Use Among Middle and
High School Students — United States, 2011–2012,” September 6, 2013, 62(35); 729-30.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm
63
64
NIH, The Science of Mental Illness http://science.education.nih.gov/supplements/nih5/mental/guide/infomental-a.htm
65
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2011.
Tables 1.1B, 1.1B, 1.3B, 1.6B and 1.8B.
http://www.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHDetTabs/NSDUHMHDetTabsLOTSect1pe2011.htm#TopOfPage
54
February 2014
66
2011 (2010 Data – Revised March 2012), Tables 1 and 24
67
NAMI State Statistics: Connecticut.
http://www.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=93484
68
Figure 6.2 http://www.oas.samhsa.gov/2k6State/ConnecticutMH.htm
69
Kaiser Family Foundation State Health Facts. http://kff.org/statedata/
70
71
72
73
County Health Ratings and Roadmaps, 2005-2011 data
http://www.countyhealthrankings.org/app/connecticut/2013/fairfield/county/outcomes/overall/snapshot/byrank
74
Spencer, Andrea M., Ph.D, “Blind Spot: Unidentified Risks to Children’s Mental Health,” Center for Children’s
Advocacy, Hartford, 2012. http://www.cthealth.org/wp-content/uploads/2011/04/2BlindSpot2012.pdf
75
76
Cabasso, Leopoldo et al., “Latino Adults’ Access to Mental Health Care. A Review of Epidemiological Studies,”
Administration and Policy in Mental Health and Mental Health Services Research, May 2006, Volume 33, Issue 3,
316-330 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551758/
77
American Psychiatric Association Office of Minority and National Affairs Fact Sheet, “Mental Health Disparities:
Hispanics/Latinos,” 2010 http://www.psychiatry.org/practice/professional-interests/diversityomna/diversityresources
78
Rodriguez, Cindy Y., “Latinos struggle to find help for mental issues,” CNN.com, October 9, 2013
http://www.cnn.com/2013/10/09/health/latino-mental-health-disparities/
79
NIMH http://www.nimh.nih.gov/health/topics/depression/index.shtml
http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
80
Pratt, Laura A. et al, “Antidepressant Use in Persons Aged 12 and Over: United States, 2005–2008,” CDC NCHS
Data Brief, No. 76, October 2011. http://www.cdc.gov/nchs/data/databriefs/db76.pdf
81
55
February 2014
82
Tables 1.53B and 1.54B
83
NIMH, “Women and Depression: Discovering Hope” http://www.nimh.nih.gov/health/publications/women-anddepression-discovering-hope/index.shtml
84
2011. Youth Table 2.6B.
85
86
2011. Youth Tables 2.6B, 2.8B and 2.13B.
87
NIMH http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
88
NIMH, “Women and Depression: Discovering Hope” http://www.nimh.nih.gov/health/publications/women-anddepression-discovering-hope/index.shtml
89
2011. Youth Tables 2.6B, 2.8B and 2.13B.
90
NIMH http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
91
92
HealthyPeople.Gov., Mental Health and Mental Disorders
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=28
93
94
56
February 2014
95
Rodriguez, Cindy Y., “Latinos struggle to find help for mental issues,” CNN.com, October 9, 2013
http://www.cnn.com/2013/10/09/health/latino-mental-health-disparities/
96
Institute of Medicine, “The Mental Health and Substance Abuse Workforce for Older Adults,” 2012
http://www.iom.edu/Reports/2012/The-Mental-Health-and-Substance-Use-Workforce-for-Older-Adults/ReportBrief.aspx
97
2012 U.S. Census. http://quickfacts.census.gov/qfd/states/09000.html
98
NIMH http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
99
Borderline Personality Disorder Resource Center of NewYork-Presbyterian Hospital
http://bpdresourcecenter.org/factsStatistics.html
100
http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
101
NIH, The Science of Mental Illness http://science.education.nih.gov/supplements/nih5/mental/guide/infomental-a.htm
102
Includes ICD-9-CM codes 290 and 293-299. Connecticut Department of Health Hospitalization Statistics, 2010,
Table H-1 http://www.ct.gov/dph/cwp/view.asp?a=3132&q=397512
103
ANAD, Eating Disorder Population by Gender in Each State http://www.anad.org/news/eating-disorderpopulation-by-gender-in-each-state/
104
2011 (2010 Data - Revised March 2012).
http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsae2011/Index.aspx
105
U.S. Census Bureau 2010 Data
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1
106
107
HealthyPeople.Gov – Mental Health and Mental Disorders.
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=28#127
108
109
CDC, “Morbidity and Mortality Weekly Report,” May 3, 2013 / 62(17); 321-325
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm?s_cid=mm6217a1_w
57
February 2014
110
CDC WISQARS (Web-based Injury Statistics Query and Reporting System) Fatal Injury Data
http://www.cdc.gov/injury/wisqars/index.html
111
Connecticut SPF-SIG State Epidemiological Workgroup (SEW), SPF-SIG Community Level Data Excel Spreadsheet
http://commed.uchc.edu/healthservices/sew/default.htm
112
Connecticut SPF-SIG State Epidemiological Workgroup (SEW), Suicide Rates by Town 2002-2004
http://commed.uchc.edu/healthservices/sew/default.htm
113
Connecticut Department of Mental Health and Addiction Services (DMHAS) Sub-Region 1B Substance Abuse
Profile, 2008.
114
http://bpdresourcecenter.org/factsStatistics.html
115
116
CDC WISQARS (Web-based Injury Statistics Query and Reporting System) Fatal Injury Data
http://www.cdc.gov/injury/wisqars/index.html
117
118
“A Profile of Latino Health in Connecticut,” Latino Policy Institute (Hartford: Hispanic Health Council, 2006), 9.
http://www.hartfordinfo.org/issues/wsd/health/Profile_Latino_Health.pdf
119
CT Department of Health, “2011 Connecticut School Health Survey Youth Behavior Component Report,” 6.
http://www.ct.gov/dph/lib/dph/hisr/pdf/YBC_2011_Report_ForWeb.pdf
120
Yablonski, Steven and Matt Campbell, WFSB, “Greenwich HS Student commits suicide on first day of school,”
Aug. 28, 2013. http://www.wfsb.com/story/23278527/greenwich-hs-student-commits-suicide-on-first-day-ofschool
121
The Ridgefield Press, “Teen suicide: Watching for signs,” November 27, 2012.
http://www.theridgefieldpress.com/11829/teen-suicide-watching-for-signs/
122
Project Resilience Facebook Page. https://www.facebook.com/ProjectResilience
123
The National Center on Addiction and Substance Abuse at Columbia University, “Addiction Medicine: Closing
the Gap Between Science and Practice,” June 2012, 52.
58
February 2014
124
125
NAMI, “Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder,” September
2003
http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=
54&ContentID=23049
126
127
128
Table 1.58B http://www.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHDetTabs/NSDUHMHDetTabsLOTSect1pe2011.htm#TopOfPage
129
http://bpdresourcecenter.org/co-occuringDisorders.html
130
Wright S. et al, “Dual diagnosis in the suburbs: prevalence, need, and in-patient service use,” Journal of Social
Psychiatry and Psychiatric Epidemiology, 2000 Jul; 35(7):297-304.
http://www.ncbi.nlm.nih.gov/pubmed/11016524
131
Table 1.19B http://www.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHDetTabs/NSDUHMHDetTabsLOTSect1pe2011.htm#TopOfPage
132
2011. Youth Table 2.10B.
133
See the Connecticut Department of Consumer Protection’s website:
http://www.ct.gov/dcp/cwp/view.asp?a=3501&q=411378
134
Kids in Crisis Program http://www.kidsincrisis.org/
59
135
February 2014
U.S. Census, 2011 http://quickfacts.census.gov/qfd/states/09000.html
136
UCONN Connecticut State Data Center, Connecticut County Projections.
http://ctsdc.uconn.edu/projections/ct_counties.html
137
U.S. Census, 2011 http://quickfacts.census.gov/qfd/states/09000.html
138
UCONN Connecticut State Data Center, Connecticut County Projections.
http://ctsdc.uconn.edu/projections/ct_counties.html
139
140
141
RAND Corporation, “Incorporating Community Groups Into Depression Care Can Improve Coping Among LowIncome Patients,” June 25, 2013 http://www.rand.org/news/press/2013/06/25.html
142
143
For more information, go to http://www.ct.gov/dph/tobacco
144
For more information on Gould Farm, visit http://www.gouldfarm.org
145
146
Connecticut Association of School Based Health Centers website: http://www.ctschoolhealth.org/index.asp
60

Silver Hill Hospital Community Health Needs Assessment

Transcription

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